Provider Demographics
NPI:1740219864
Name:MARQUETTE INTERNAL MEDICINE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MARQUETTE INTERNAL MEDICINE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN ESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-225-4500
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-4500
Mailing Address - Fax:906-225-3919
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-4500
Practice Address - Fax:906-225-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE26038OtherBLUE CROSS/BLUE SHIELD
MIOE26038Medicare ID - Type UnspecifiedMEDICARE NUMBER