Healthcare Provider Details

I. General information

NPI: 1649472770
Provider Name (Legal Business Name): MARQUETTE REHABILITATION, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE SUITE 206
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

1414 W FAIR AVE SUITE 206
MARQUETTE MI
49855-2675
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-7160
  • Fax: 906-225-7165
Mailing address:
  • Phone: 906-225-7160
  • Fax: 906-225-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number4301407225
License Number StateMI

VIII. Authorized Official

Name: DR. RICHARD E VERMEULEN
Title or Position: PRESIDENT
Credential: MD
Phone: 906-225-7160