Individual
MARISSA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
201 SAINT ANN DR STE B, MANDEVILLE, LA 70471-3472
(985) 898-4001
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
333248
LA
207Q00000X
Family Medicine Physician
Primary
4301514377
MI
Other
Enumeration date
04/04/2019
Last updated
09/17/2025
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