MEDICARE: MARLETTE REGIONAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	MO009325	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	010G664991	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1376695205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARLETTE REGIONAL HOSPITAL

Provider Business Mailing Address
First Line	:	4472 MAIN ST
Second Line	:
City	:	BROWN CITY
State	:	MI
Zip	:	48416-7908
Country	:	US
Telephone Number	:	810-346-2751
Fax Number	:	810-346-3238

Provider Business Practice Location Address
First Line	:	4472 MAIN ST
Second Line	:
City	:	BROWN CITY
State	:	MI
Zip	:	48416-7908
Country	:	US
Telephone Number	:	810-346-2751
Fax Number	:	810-346-3238

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. DANIEL KULICK
Credential	:	D.O.
Telephone Number	:	810-346-2751

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/21/2017

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Directions to “MARLETTE REGIONAL HOSPITAL ” Practice Location

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