=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366474066
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARQUETTE GENERAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1414 W FAIR AVE STE 332
-----------------------------------------------------
City | MARQUETTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49855-5407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-225-3922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1414 W FAIR AVE STE 332
-----------------------------------------------------
City | MARQUETTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49855-5407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-225-3922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | MRS. SHEETAL S ACHARYA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 906-225-3922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 4301086286
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------