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General NPI Number Information
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NPI Number | 1497483440
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Entity Type | Organization
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Legal Business Name | NORTHCOUNTRY HEALTH OF MARQUETTE, PC
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 717 W WASHINGTON ST STE A
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City | MARQUETTE
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State | MI
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Zip | 49855-4100
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Country | US
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Telephone | 906-936-3499
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Fax | 906-224-2562
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Provider Business Mailing Address
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Address Line | 717 W WASHINGTON ST STE A
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City | MARQUETTE
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State | MI
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Zip | 49855-4100
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Country | US
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Telephone | 906-936-3499
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Fax | 906-224-2562
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Authorized Official
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Title or Position | CEO
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Name | DR. RYAN BRANG
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Credential | MD
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Telephone | 906-250-9160
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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 |
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License Number State |
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