Healthcare Provider Details

I. General information

NPI: 1316128606
Provider Name (Legal Business Name): MARION ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 ROSELAND AVE
ELKHART IN
46514-1405
US

IV. Provider business mailing address

2115 ROSELAND AVE
ELKHART IN
46514-1405
US

V. Phone/Fax

Practice location:
  • Phone: 574-293-9922
  • Fax: 574-293-7856
Mailing address:
  • Phone: 574-293-9922
  • Fax: 574-293-7856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01018291
License Number StateIN

VIII. Authorized Official

Name: DR. GEORGE AURTHUR MARK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 574-293-9922