Individual
TATJANA MARIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
420 BALTIMORE DR NE, GRAND RAPIDS, MI 49503-3934
(323) 633-3503
Mailing address
420 BALTIMORE DR NE, GRAND RAPIDS, MI 49503-3934
(323) 633-3503
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
1164712055
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/12/2011
Last updated
02/15/2017
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