Provider Demographics
NPI:1568718062
Name:DLP MARQUETTE PHYSICIAN PRACTICES INC
Entity Type:Organization
Organization Name:DLP MARQUETTE PHYSICIAN PRACTICES INC
Other - Org Name:SAULT STE.MARIE CHIPPEWA MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:510 ASHMUN ST
Mailing Address - Street 2:STE 5
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1964
Mailing Address - Country:US
Mailing Address - Phone:906-632-8618
Mailing Address - Fax:906-632-8618
Practice Address - Street 1:510 ASHMUN ST
Practice Address - Street 2:STE 5
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1964
Practice Address - Country:US
Practice Address - Phone:906-632-8618
Practice Address - Fax:906-632-8618
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DLP MARQUETTE PHYSICIAN PRACTICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty