| Doctor Name: | DR. MARCO JOHN DI BIASE |
| NPI Number: | 1144236373 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 1427016 |
| Business Practice Address: | 4983 Appian Way Berrien Springs, MI - 491039558 |
| Business Phone Number: | 2694733195 |
| Business Fax Number: | |
| Mailing Address: | 4983 Appian Way, BERRIEN SPRINGS |
| State: | MI |
| Postal Code: | 491039558 |
| Phone Number: | 2694733195 |
| Fax Number: | |
| NPI Enumeration Date: | 07/31/2006 |
| NPI Last Update Date: | 07/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 1427016 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |