MEDICARE: VINCENT R.C. MARIBAO MD PC

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730114760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINCENT R.C. MARIBAO MD PC

Provider Business Mailing Address
First Line	:	29167 JEFFERSON AVE STE 100
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1331
Country	:	US
Telephone Number	:	586-498-1160
Fax Number	:

Provider Business Practice Location Address
First Line	:	29167 JEFFERSON AVE STE 100
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1331
Country	:	US
Telephone Number	:	586-498-1160
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VINCENT R. C. MARIBAO
Credential	:	MD
Telephone Number	:	586-498-1160

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	10/01/2019

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