Provider Demographics
NPI:1861428021
Name:DAIG, MARCUS ALAN (PA)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:ALAN
Last Name:DAIG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8201 KENSINGTON BLVD APT 633
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-3119
Mailing Address - Country:US
Mailing Address - Phone:810-223-6032
Mailing Address - Fax:
Practice Address - Street 1:1083 SUNCREST DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4403
Practice Address - Country:US
Practice Address - Phone:810-667-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004811363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP36120002Medicare PIN