Provider Demographics
NPI:1376695205
Name:MARLETTE REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:MARLETTE REGIONAL HOSPITAL
Other - Org Name:FAMILY HEALTHCARE OF BROWN CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KULICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-346-2751
Mailing Address - Street 1:4472 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416-7908
Mailing Address - Country:US
Mailing Address - Phone:810-346-2751
Mailing Address - Fax:810-346-3238
Practice Address - Street 1:4472 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWN CITY
Practice Address - State:MI
Practice Address - Zip Code:48416-7908
Practice Address - Country:US
Practice Address - Phone:810-346-2751
Practice Address - Fax:810-346-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMO009325261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2862561Medicaid
MI010G664991OtherBCBSM
MIG66499001Medicare PIN
MIP16043Medicare UPIN
MI238577Medicare Oscar/Certification
MI010G664991OtherBCBSM