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NPI Code Detail

MEDICARE: JOHNATHON MCDONNELL-MARCKS

MEDICARE: JOHNATHON MCDONNELL-MARCKS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156F00000XTechnician/Technologist

General Provider Information

NPI Number : 1518713148
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNATHON MCDONNELL-MARCKS
Provider Business Mailing Address
First Line : 1100 W NEWARK RD
Second Line :
City : LAPEER
State : MI
Zip : 48446-9449
Country : US
Telephone Number : 810-358-0373
Fax Number :
Provider Business Practice Location Address
First Line : 2222 N LAPEER RD
Second Line :
City : LAPEER
State : MI
Zip : 48446-8619
Country : US
Telephone Number : 810-358-0373
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2024
Last Update Date : 04/25/2024

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Directions to “ JOHNATHON MCDONNELL-MARCKS ” Practice Location

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