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General NPI Number Information
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NPI Number | 1700929411
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Entity Type | Organization
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Legal Business Name | U. P. DIGESTIVE DISEASE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 1414 W FAIR AVE STE 247
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City | MARQUETTE
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State | MI
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Zip | 49855-2675
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Country | US
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Telephone | 906-225-3880
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Fax | 906-225-4523
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Provider Business Mailing Address
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Address Line | 1414 W FAIR AVE STE 247
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City | MARQUETTE
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State | MI
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Zip | 49855-2675
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Country | US
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Telephone | 906-225-3880
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Fax | 906-225-4523
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | CHERYL LIUBAKKA
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Credential | CPA
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Telephone | 906-225-3880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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