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General NPI Number Information
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NPI Number | 1184983884
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Entity Type | Organization
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Legal Business Name | MEDICAL ACNE & SKIN CARE
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 150 W. RIDGE ST.
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City | MARQUETTE
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State | MI
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Zip | 49855
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Country | US
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Telephone | 906-235-4486
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Fax | 906-680-4077
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Provider Business Mailing Address
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Address Line | 150 W. RIDGE ST.
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City | MARQUETTE
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State | MI
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Zip | 49855
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Country | US
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Telephone | 906-235-4486
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Fax | 906-680-4077
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHRISTINE MATTILA
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Credential |
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Telephone | 906-235-4486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301066449
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License Number State | MI
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