| Doctor Name: | DR. BASIL JOHN MARRELLA |
| NPI Number: | 1407833270 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 5101006788 |
| Business Practice Address: | 30855 John R Rd Madison Heights, MI - 480715213 |
| Business Phone Number: | 2485830100 |
| Business Fax Number: | 2485834894 |
| Mailing Address: | 30855 John R Rd, MADISON HEIGHTS |
| State: | MI |
| Postal Code: | 480715213 |
| Phone Number: | 2485830100 |
| Fax Number: | 2485834894 |
| NPI Enumeration Date: | 12/22/2005 |
| NPI Last Update Date: | 12/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5101006788 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |