Healthcare Provider Details

I. General information

NPI: 1902167737
Provider Name (Legal Business Name): RACHEL B MARCUCCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL B BEREDO

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 FARMINGTON RD STE 105
LIVONIA MI
48154-5431
US

IV. Provider business mailing address

14600 FARMINGTON RD STE 105
LIVONIA MI
48154-5431
US

V. Phone/Fax

Practice location:
  • Phone: 734-655-8200
  • Fax:
Mailing address:
  • Phone: 734-655-8200
  • Fax: 734-655-8213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301100941
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301100941
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: