MEDICARE: MARCEREAU AND CICHOWLAS FAMILY PRACTICE PLC

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	207Q00000X	Family Medicine Physician	MC012049	MI

General Provider Information

NPI Number	:	1922158229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCEREAU AND CICHOWLAS FAMILY PRACTICE PLC

Provider Business Mailing Address
First Line	:	37771 SCHOENHERR RD
Second Line	:	SUITE 104
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-2302
Country	:	US
Telephone Number	:	586-274-2400
Fax Number	:	586-274-2426

Provider Business Practice Location Address
First Line	:	37771 SCHOENHERR RD
Second Line	:	SUITE 104
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-2302
Country	:	US
Telephone Number	:	586-274-2400
Fax Number	:	586-274-2426

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MICHAEL CICHOWLAS
Credential	:	D.O.
Telephone Number	:	586-274-2400

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	08/22/2020

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