Provider Demographics
NPI:1366474066
Name:MARQUETTE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:MARQUETTE GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEETAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ACHARYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-225-3922
Mailing Address - Street 1:1414 W FAIR AVE STE 332
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5407
Mailing Address - Country:US
Mailing Address - Phone:906-225-3922
Mailing Address - Fax:
Practice Address - Street 1:1414 W FAIR AVE STE 332
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5407
Practice Address - Country:US
Practice Address - Phone:906-225-3922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4781364Medicaid
MII43820Medicare UPIN
MION15070011Medicare ID - Type Unspecified