Healthcare Provider Details

I. General information

NPI: 1790033207
Provider Name (Legal Business Name): DLP MARQUETTE PHYSICIAN PRACTICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W ICE LAKE RD
IRON RIVER MI
49935-8509
US

IV. Provider business mailing address

1500 W ICE LAKE RD
IRON RIVER MI
49935-8509
US

V. Phone/Fax

Practice location:
  • Phone: 906-265-5378
  • Fax: 906-265-6332
Mailing address:
  • Phone: 906-265-5378
  • Fax: 906-265-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESS N JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-372-8500