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General NPI Number Information
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NPI Number | 1629071170
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Entity Type | Individual
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Provider Name | MARSHALL BARNETT SACK D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/28/2005
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 39500 W 10 MILE RD STE. 100
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City | NOVI
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State | MI
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Zip | 48375-2947
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Country | US
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Telephone | 248-476-0035
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Fax | 248-476-2418
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Provider Business Mailing Address
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Address Line | 39500 W 10 MILE RD STE. 100
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City | NOVI
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State | MI
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Zip | 48375-2947
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Country | US
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Telephone | 248-476-0035
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Fax | 248-476-2418
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101007596
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License Number State | MI
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