Healthcare Provider Details

I. General information

NPI: 1043120207
Provider Name (Legal Business Name): MADELINE MARSIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23100 JEFFERSON AVE
SAINT CLAIR SHORES MI
48080-2756
US

IV. Provider business mailing address

21234 PARKCREST DR
HARPER WOODS MI
48225-1766
US

V. Phone/Fax

Practice location:
  • Phone: 586-335-2006
  • Fax: 586-279-3886
Mailing address:
  • Phone: 586-335-2006
  • Fax: 586-279-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: