Provider Demographics
NPI:1184681256
Name:MARQUETTE GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:MARQUETTE GENERAL HOSPITAL, INC.
Other - Org Name:DOCTORS PARK FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:A. GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-225-4821
Mailing Address - Street 1:4602 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0021
Mailing Address - Country:US
Mailing Address - Phone:906-225-4533
Mailing Address - Fax:906-225-4537
Practice Address - Street 1:2500 7TH AVE S
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1176
Practice Address - Country:US
Practice Address - Phone:906-786-4628
Practice Address - Fax:906-789-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICA7435OtherRAILROAD MEDICARE
MIRR1029OtherRAILROAD
MI0B11008OtherBCBSM GROUP NUMBER
MIC31351OtherRAILROAD MEDICARE
MICA1145OtherRAILROAD MEDICARE
MICI0319OtherRAILROAD MEDICARE
MI=========013OtherTRICARE GROUP NUMBER
MI=========013OtherTRICARE GROUP NUMBER