Provider Demographics
NPI:1679091540
Name:MARCUS K FREE MD PLLC
Entity Type:Organization
Organization Name:MARCUS K FREE MD PLLC
Other - Org Name:HARBOR SHORES MEDICAL, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:FREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-404-2521
Mailing Address - Street 1:2143 DERFLA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9661
Mailing Address - Country:US
Mailing Address - Phone:810-404-2521
Mailing Address - Fax:888-414-4545
Practice Address - Street 1:59057 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MI
Practice Address - Zip Code:48048-2057
Practice Address - Country:US
Practice Address - Phone:810-404-2521
Practice Address - Fax:888-414-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093347261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care