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General NPI Number Information
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NPI Number | 1396751061
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Entity Type | Organization
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Legal Business Name | ANTHONY MARL DO PLLC
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1505 WATERFORD PKWY
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City | SAINT JOHNS
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State | MI
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Zip | 48879-9630
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Country | US
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Telephone | 989-227-1621
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 PACIFIC AVE
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City | LANSING
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State | MI
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Zip | 48910-3565
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Country | US
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Telephone | 517-316-1063
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY E MARL
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Credential | DO
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Telephone | 517-316-1063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101015680
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License Number State | MI
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