Healthcare Provider Details

I. General information

NPI: 1134823735
Provider Name (Legal Business Name): MARC ANTHONY DIGRANDE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18010 MACK AVE
GROSSE POINTE MI
48230-6235
US

IV. Provider business mailing address

19984 RIVERWOODS CT # 2
MACOMB MI
48044-5762
US

V. Phone/Fax

Practice location:
  • Phone: 313-882-7480
  • Fax:
Mailing address:
  • Phone: 248-739-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901400613
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: