Healthcare Provider Details

I. General information

NPI: 1922354620
Provider Name (Legal Business Name): DLP MARQUETTE PHYSICIAN PRACTICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE STE 190
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

1414 W FAIR AVE STE 190
MARQUETTE MI
49855-2675
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-1321
  • Fax: 906-225-9371
Mailing address:
  • Phone: 906-225-1321
  • Fax: 906-225-9371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

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