Provider Demographics
NPI:1427383009
Name:MARQUETTE GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:MARQUETTE GENERAL HOSPITAL, INC.
Other - Org Name:MARQUETTE GENERAL MEDICAL GROUP RADIOLOGY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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:906-225-4774
Mailing Address - Street 1:4633 DEPARTMENT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4633
Mailing Address - Country:US
Mailing Address - Phone:614-217-8322
Mailing Address - Fax:614-248-6549
Practice Address - Street 1:580 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2705
Practice Address - Country:US
Practice Address - Phone:906-225-3540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty