Healthcare Provider Details

I. General information

NPI: 1629117411
Provider Name (Legal Business Name): JAMES W GALLAGHER DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE STE 290
MARQUETTE MI
49855-2683
US

IV. Provider business mailing address

1414 W FAIR AVE STE 290
MARQUETTE MI
49855-2683
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-4782
  • Fax: 906-225-7835
Mailing address:
  • Phone: 906-225-4782
  • Fax: 906-225-7835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number5901001221
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number5901001221
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5901001221
License Number StateMI

VIII. Authorized Official

Name: HEATHER L FRUSTAGLIO
Title or Position: OFFICE MANAGER
Credential:
Phone: 906-225-4782