Provider Demographics
NPI:1548374788
Name:MARCHENA, CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:MARCHENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2464 WEXFORD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2712
Mailing Address - Country:US
Mailing Address - Phone:248-703-0995
Mailing Address - Fax:
Practice Address - Street 1:3170 S PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-667-8872
Practice Address - Fax:989-686-8514
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICM040033207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI303750Medicaid
MIP41306OtherBLUE CARE NETWORK
MI0090010OtherBLUE CROSS BLUE SHIELD MI
MIXX27323OtherHEALTHPLUS OF MI
MIXX27323OtherHEALTHPLUS OF MI
MI0090010OtherBLUE CROSS BLUE SHIELD MI