Provider Demographics
NPI:1497503361
Name:COREA DEL CID, MARCO TULIO (MD)
Entity type:Individual
Prefix:MR
First Name:MARCO
Middle Name:TULIO
Last Name:COREA DEL CID
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 1:27483 DEQUINDRE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5715
Mailing Address - Country:US
Mailing Address - Phone:248-546-2600
Mailing Address - Fax:248-546-2604
Practice Address - Street 1:27483 DEQUINDRE RD STE 301
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5715
Practice Address - Country:US
Practice Address - Phone:248-546-2600
Practice Address - Fax:248-546-2604
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1497503361390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program