Individual
MARJORIE V FUNTANILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
4301071282
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110191045
RR MEDICARE
MN
01
—
1102200711
BCBS MI
MI
05
—
32482700
—
WI
05
—
3498057
—
MI
Enumeration date
11/17/2005
Last updated
07/10/2012
Update your record
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