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General NPI Number Information
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NPI Number | 1518466143
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDIC SURGERY ASSOCIATES OF MARQUETTE PC
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Dates
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Enumeration Date | 02/09/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 841 WEST WASHINGTON STREET SUITE 100
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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 | 906-225-1321
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Fax | 906-228-9371
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Provider Business Mailing Address
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Address Line | 841 W WASHINGTON ST STE 100
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City | MARQUETTE
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State | MI
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Zip | 49855-4139
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Country | US
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Telephone | 906-225-1321
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Fax | 906-228-9371
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DALE MOILANEN
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Credential |
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Telephone | 906-227-5624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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