Healthcare Provider Details

I. General information

NPI: 1730199845
Provider Name (Legal Business Name): ORTHOPAEDIC SURGERY ASSOCIATES OF MARQUETTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE SUITE 190
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

1414 W FAIR AVE SUITE 190
MARQUETTE MI
49855-2675
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 TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4301050335
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number4301050335
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301050335
License Number StateMI

VIII. Authorized Official

Name: DR. MATTHEW NEWBERG SONGER
Title or Position: PRESIDENT
Credential: MD
Phone: 906-225-1321