Individual
DR. MARILYNN SULTANA-GALLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
29753 HOOVER RD, STE A, WARREN, MI 48093-8900
(586) 573-4333
(586) 573-2149
Mailing address
29753 HOOVER RD, STE A, WARREN, MI 48093-8900
(586) 573-4333
(586) 573-2149
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301047297
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1805005281
BLUE SHIELD OF MICHIGAN
MI
05
—
3336110
—
MI
05
—
33361100
—
MI
Enumeration date
05/31/2005
Last updated
01/22/2020
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