Provider Demographics
NPI:1104664853
Name:GIANT, MARC L
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:L
Last Name:GIANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WASHINGTON AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1367
Mailing Address - Country:US
Mailing Address - Phone:248-404-7939
Mailing Address - Fax:
Practice Address - Street 1:100 WASHINGTON AVE APT 306
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1367
Practice Address - Country:US
Practice Address - Phone:248-404-7939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86027488133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered