Healthcare Provider Details

I. General information

NPI: 1891100863
Provider Name (Legal Business Name): MARIAN DEAMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 11/03/2023
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 SMITH RD
LAMBERTVILLE MI
48144-9434
US

IV. Provider business mailing address

3175 SMITH RD
LAMBERTVILLE MI
48144-9434
US

V. Phone/Fax

Practice location:
  • Phone: 734-856-5494
  • Fax: 734-856-7184
Mailing address:
  • Phone: 734-856-5494
  • Fax: 734-856-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2017-0552
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301105369
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: