Provider Demographics
NPI:1497944433
Name:PSYCHIATRIC ASSOCIATES OF MARQUETTE
Entity Type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES OF MARQUETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-226-6802
Mailing Address - Street 1:450 E RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4215
Mailing Address - Country:US
Mailing Address - Phone:906-226-6802
Mailing Address - Fax:
Practice Address - Street 1:450 E RIDGE ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4215
Practice Address - Country:US
Practice Address - Phone:906-226-6802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010537832084P0800X
MI43010551592084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE26372Medicare PIN