Healthcare Provider Details

I. General information

NPI: 1902157027
Provider Name (Legal Business Name): DLP MARQUETTE PHYSICIAN PRACTICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W MAGNETIC ST
MARQUETTE MI
49855-2700
US

IV. Provider business mailing address

420 W MAGNETIC ST
MARQUETTE MI
49855-2700
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-3466
  • Fax:
Mailing address:
  • Phone: 906-225-3466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

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