Healthcare Provider Details

I. General information

NPI: 1902154412
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

580 W COLLEGE AVE
MARQUETTE MI
49855-2736
US

IV. Provider business mailing address

580 W COLLEGE AVE
MARQUETTE MI
49855-2736
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-4575
  • Fax: 906-225-7781
Mailing address:
  • Phone: 906-225-4575
  • Fax: 906-225-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

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