Healthcare Provider Details

I. General information

NPI: 1619935012
Provider Name (Legal Business Name): MARQUETTE GENERAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE STE 226
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

4602 DEPT
CAROL STREAM IL
60122-0021
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-3925
  • Fax: 906-225-4838
Mailing address:
  • Phone: 906-225-4533
  • Fax: 906-225-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. A. GARY MULLER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 906-225-3925