Individual
COLBY L MAIORANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.C
Contact information
Practice address
4201 SAINT ANTOINE ST, SUITE 3R, DETROIT, MI 48201-2153
(313) 745-3330
Mailing address
21031 MICHIGAN AVE, DEARBORN, MI 48124-2339
(313) 277-6700
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
5601006690
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12564682
CAQH
—
Enumeration date
12/08/2010
Last updated
02/21/2019
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