Basic Information
| Provider Information | |||||||||
| NPI: | 1104078617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOISI | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4160 JOHN R ST STE 930 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138310777 | ||||||||
| FaxNumber: | 3139930303 | ||||||||
| Practice Location | |||||||||
| Address1: | 4160 JOHN R ST STE 930 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137457247 | ||||||||
| FaxNumber: | 3139930500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2008 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 4301109519 | MI | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.