Healthcare Provider Details

I. General information

NPI: 1093467136
Provider Name (Legal Business Name): DANIEL JAMES MARCATH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 PINE GROVE AVE
PORT HURON MI
48060-3511
US

IV. Provider business mailing address

3808 PARKER RD
FORT GRATIOT MI
48059-4130
US

V. Phone/Fax

Practice location:
  • Phone: 810-989-3620
  • Fax:
Mailing address:
  • Phone: 810-357-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704324110
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704324110
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: