Healthcare Provider Details

I. General information

NPI: 1376695205
Provider Name (Legal Business Name): MARLETTE REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4472 MAIN ST
BROWN CITY MI
48416-7908
US

IV. Provider business mailing address

4472 MAIN ST
BROWN CITY MI
48416-7908
US

V. Phone/Fax

Practice location:
  • Phone: 810-346-2751
  • Fax: 810-346-3238
Mailing address:
  • Phone: 810-346-2751
  • Fax: 810-346-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberMO009325
License Number StateMI

VIII. Authorized Official

Name: DR. DANIEL KULICK
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 810-346-2751