Healthcare Provider Details

I. General information

NPI: 1568870004
Provider Name (Legal Business Name): MICHAEL F DUCKWALL FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE STE 344
MARQUETTE MI
49855-5407
US

IV. Provider business mailing address

1414 W FAIR AVE STE 344
MARQUETTE MI
49855-5407
US

V. Phone/Fax

Practice location:
  • Phone: 906-449-1300
  • Fax: 906-451-5801
Mailing address:
  • Phone: 906-449-1300
  • Fax: 906-451-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704313103
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704313103
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: