Basil John Marrella, DO

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

5101006788 Issued in MI

Practice address

30855 John R Rd
Madison Heights, MI 48071-5213

Phone

(248) 583-0100

Fax

(248) 583-4894

NPI assigned

Dec 22, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northern Phototherapy Management Facility LLC

  • Internal Medicine Physician
  • West Branch, MI
  • NPI 1831251982
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325030400000",
    "number": "1407833270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30855 JOHN R RD",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480715213",
            "telephone_number": "248-583-0100",
            "fax_number": "248-583-4894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30855 JOHN R RD",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480715213",
            "telephone_number": "248-583-0100",
            "fax_number": "248-583-4894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARRELLA",
        "first_name": "BASIL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2011-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "5101006788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114788740",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon Paul Marentette, PHARMD
• Harold Margolis, DO
• Jeffrey H. Margolis, M.D.
• Angel Marino
• Girija Maripudi, MD
• Nicholas Martini, PT, DPT
• John D. Marx, D.D.S., M.S.
• Matthew B. Cohen DC, PLLC
• Kaylee Renee Maust, SLP
• Max Rehab Physical Therapy, LLC

• General Practice Physician in Madison Heights, MI
• Providers in Madison Heights, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.