MEDICARE: DR. MARISSA B. CATALAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	4301061651	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1021715	OTHER	MI	MHP HAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	350D410030	OTHER	MI	BCBSM BCN BLUE CHOICE

General Provider Information

NPI Number	:	1619935921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISSA B. CATALAN M.D.

Provider Business Mailing Address
First Line	:	22500 METROPOLITAN PKWY
Second Line	:	STE 201
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-1904
Country	:	US
Telephone Number	:	810-342-1000
Fax Number	:	810-342-1590

Provider Business Practice Location Address
First Line	:	36500 S GRATIOT AVE
Second Line	:	STE. 101
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-1772
Country	:	US
Telephone Number	:	586-493-3732
Fax Number	:	586-493-3739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	03/29/2019

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Directions to “ DR. MARISSA B. CATALAN M.D.” Practice Location

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