Healthcare Provider Details

I. General information

NPI: 1518466143
Provider Name (Legal Business Name): ORTHOPAEDIC SURGERY ASSOCIATES OF MARQUETTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 WEST WASHINGTON STREET SUITE 100
MARQUETTE MI
49855
US

IV. Provider business mailing address

841 W WASHINGTON ST STE 100
MARQUETTE MI
49855-4139
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-1321
  • Fax: 906-228-9371
Mailing address:
  • Phone: 906-225-1321
  • Fax: 906-228-9371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DALE MOILANEN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 906-227-5624