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General NPI Number Information
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NPI Number | 1669772505
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Entity Type | Organization
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Legal Business Name | MARATHON MEDICAL CLINIC, P.C.
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 4526 PINE ST
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City | COLUMBIAVILLE
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State | MI
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Zip | 48421-8920
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Country | US
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Telephone | 810-793-7550
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Fax | 810-793-7962
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | COLUMBIAVILLE
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State | MI
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Zip | 48421-0007
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Country | US
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Telephone | 810-793-7550
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Fax | 810-793-7962
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ABNER J ESPINOSA
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Credential | M.D.
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Telephone | 810-793-7550
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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 | 4301039120
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License Number State | MI
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