Provider Demographics
NPI:1962794305
Name:PULCINI, MAREN (PA-C)
Entity type:Individual
Prefix:
First Name:MAREN
Middle Name:
Last Name:PULCINI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FORD PL
Mailing Address - Street 2:2F, DEPARTMENT OF FAMILY MEDICINE
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3450
Mailing Address - Country:US
Mailing Address - Phone:313-732-1305
Mailing Address - Fax:313-874-4677
Practice Address - Street 1:1 FORD PL
Practice Address - Street 2:2F, DEPARTMENT OF FAMILY MEDICINE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3450
Practice Address - Country:US
Practice Address - Phone:313-732-1305
Practice Address - Fax:313-874-4677
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant