Individual
MARILENA C ORAVITAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1310 WISCONSIN ST, SUITE 100, GRAND HAVEN, MI 49417-2472
(616) 844-4701
(616) 847-1863
Mailing address
1310 WISCONSIN ST STE 101, GRAND HAVEN, MI 49417-2472
(616) 296-1600
(616) 296-1602
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
116
ZZ
207R00000X
Internal Medicine Physician
Primary
4301089425
MI
Other
Enumeration date
04/28/2006
Last updated
01/31/2022
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