Individual
MARIANN M CHANNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
21711 GREATER MACK AVE, ST CLAIR SHORES, MI 48080-2418
(586) 774-0393
Mailing address
21711 GREATER MACK AVE, ST CLAIR SHORES, MI 48080-2418
(586) 774-0393
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301043844
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180002293
MEDICARE RAILROAD
MI
Enumeration date
06/01/2005
Last updated
06/03/2008
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