Healthcare Provider Details

I. General information

NPI: 1487601548
Provider Name (Legal Business Name): MARLA M SIGNS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 MITCHELL PARK DR SUITE A
PETOSKEY MI
49770-8965
US

IV. Provider business mailing address

2390 MITCHELL PARK DR SUITE A
PETOSKEY MI
49770-8965
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-2250
  • Fax: 231-348-7972
Mailing address:
  • Phone: 231-487-2250
  • Fax: 231-348-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101008677
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: