Provider Demographics
NPI:1164863098
Name:MARCO, MICHAEL REDA LATIF (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:REDA LATIF
Last Name:MARCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1650 SELWYN AVE
Mailing Address - Street 2:MILSTEIN 4A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7626
Mailing Address - Country:US
Mailing Address - Phone:412-627-0404
Mailing Address - Fax:718-960-1370
Practice Address - Street 1:1650 SELWYN AVE
Practice Address - Street 2:MILSTEIN 4A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7626
Practice Address - Country:US
Practice Address - Phone:412-627-0404
Practice Address - Fax:718-960-1370
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA10593900208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program