Healthcare Provider Details

I. General information

NPI: 1902860695
Provider Name (Legal Business Name): MARQUETTE GENERAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EAST BLVD
KINGSFORD MI
49802-4436
US

IV. Provider business mailing address

4602 DEPT
CAROL STREAM IL
60122-0021
US

V. Phone/Fax

Practice location:
  • Phone: 906-774-4000
  • Fax: 906-774-0088
Mailing address:
  • Phone: 906-225-4533
  • Fax: 906-225-4537

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: MR. A. GARY MULLER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 906-225-4821