Provider Demographics
NPI:1073861431
Name:DLP MARQUETTE PHYSICIAN PRACTICES INC
Entity Type:Organization
Organization Name:DLP MARQUETTE PHYSICIAN PRACTICES INC
Other - Org Name:MARQUETTE GENERAL HEART AND VASCULAR INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:STE 334
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-3870
Mailing Address - Fax:906-225-3975
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:STE 334
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-3870
Practice Address - Fax:906-225-3975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DLP MARQUETTE PHYSICIAN PRACTICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-16
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty