Healthcare Provider Details

I. General information

NPI: 1669772505
Provider Name (Legal Business Name): MARATHON MEDICAL CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4526 PINE ST
COLUMBIAVILLE MI
48421-8920
US

IV. Provider business mailing address

PO BOX 7
COLUMBIAVILLE MI
48421-0007
US

V. Phone/Fax

Practice location:
  • Phone: 810-793-7550
  • Fax: 810-793-7962
Mailing address:
  • Phone: 810-793-7550
  • Fax: 810-793-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301039120
License Number StateMI

VIII. Authorized Official

Name: DR. ABNER J ESPINOSA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 810-793-7550