Healthcare Provider Details

I. General information

NPI: 1073615092
Provider Name (Legal Business Name): MARECK FAMILY AND GERIATRIC SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3493 WOODS EDGE DR SUITE 103
OKEMOS MI
48864-6030
US

IV. Provider business mailing address

3493 WOODS EDGE DR SUITE 103
OKEMOS MI
48864-6030
US

V. Phone/Fax

Practice location:
  • Phone: 517-886-3707
  • Fax: 517-349-1973
Mailing address:
  • Phone: 517-886-3707
  • Fax: 517-349-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY WILLIAM POLLITZ
Title or Position: CEO/PRESIDENT
Credential: LMSW
Phone: 517-886-3707