Healthcare Provider Details

I. General information

NPI: 1366790727
Provider Name (Legal Business Name): DLP MARQUETTE PHYSICIAN PRACTICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 03/09/2025
Certification Date: 03/09/2025
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: 906-225-3370
Mailing address:
  • Phone: 906-225-3466
  • Fax: 906-225-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000