Provider Demographics
NPI:1629392188
Name:MARATHON OIL COMPANY
Entity Type:Organization
Organization Name:MARATHON OIL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GURCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MSN NP-C
Authorized Official - Phone:313-297-6003
Mailing Address - Street 1:1300 S FORT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48217-1208
Mailing Address - Country:US
Mailing Address - Phone:313-297-6003
Mailing Address - Fax:313-843-9419
Practice Address - Street 1:1300 S FORT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48217-1208
Practice Address - Country:US
Practice Address - Phone:313-297-6003
Practice Address - Fax:313-843-9419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704159126363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty