Provider Demographics
NPI:1861210718
Name:MARCEAU, VINCE J
Entity type:Individual
Prefix:
First Name:VINCE
Middle Name:J
Last Name:MARCEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12432 PRELUDE CIR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48315-1493
Mailing Address - Country:US
Mailing Address - Phone:586-453-2367
Mailing Address - Fax:
Practice Address - Street 1:3925 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2287
Practice Address - Country:US
Practice Address - Phone:989-341-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant