Healthcare Provider Details

I. General information

NPI: 1053667550
Provider Name (Legal Business Name): DLP MARQUETTE PHYSICIAN PRACTICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 03/09/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 MINNEAPOLIS AVE
GLADSTONE MI
49837-2027
US

IV. Provider business mailing address

2002 MINNEAPOLIS AVE
GLADSTONE MI
49837-2027
US

V. Phone/Fax

Practice location:
  • Phone: 906-428-1856
  • Fax: 906-728-1960
Mailing address:
  • Phone: 906-428-1856
  • Fax: 906-728-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000