Provider Demographics
NPI:1730199845
Name:ORTHOPAEDIC SURGERY ASSOCIATES OF MARQUETTE PC
Entity type:Organization
Organization Name:ORTHOPAEDIC SURGERY ASSOCIATES OF MARQUETTE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:NEWBERG
Authorized Official - Last Name:SONGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-225-1321
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-1321
Mailing Address - Fax:906-228-9371
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-1321
Practice Address - Fax:906-228-9371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050335332B00000X, 335E00000X, 207X00000X
2082S0105X, 2086S0122X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E26013OtherBLUE CROSS BLUE SHIELD MI
MI0325640001Medicare NSC
MI0E23016Medicare UPIN