Provider Demographics
NPI:1861748568
Name:DLP MARQUETTE PHYSICIAN PRACTICES INC
Entity type:Organization
Organization Name:DLP MARQUETTE PHYSICIAN PRACTICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-372-8500
Mailing Address - Street 1:107 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4651
Mailing Address - Country:US
Mailing Address - Phone:906-225-7188
Mailing Address - Fax:906-228-0178
Practice Address - Street 1:107 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4651
Practice Address - Country:US
Practice Address - Phone:906-225-7188
Practice Address - Fax:906-228-0178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DLP MARQUETTE PHYSICIAN PRACTICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty