Healthcare Provider Details

I. General information

NPI: 1265780621
Provider Name (Legal Business Name): DLP MARQUETTE PHYSICIAN PRACTICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE STE 35
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

1414 W FAIR AVE STE 35
MARQUETTE MI
49855-2675
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-4555
  • Fax: 906-225-4554
Mailing address:
  • Phone: 906-225-4555
  • Fax: 906-225-4554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MONICA BOWMAN
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7000