Healthcare Provider Details

I. General information

NPI: 1497944433
Provider Name (Legal Business Name): PSYCHIATRIC ASSOCIATES OF MARQUETTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E RIDGE ST
MARQUETTE MI
49855-4215
US

IV. Provider business mailing address

450 E RIDGE ST
MARQUETTE MI
49855-4215
US

V. Phone/Fax

Practice location:
  • Phone: 906-226-6802
  • Fax:
Mailing address:
  • Phone: 906-226-6802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301053783
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301055159
License Number StateMI

VIII. Authorized Official

Name: DR. JOSEPH MICHAEL COOLS
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 906-226-6802