Provider Demographics
NPI:1851358501
Name:MARQUETTE GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:MARQUETTE GENERAL HOSPITAL, INC.
Other - Org Name:U.P. INTERNAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:A. GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-225-4821
Mailing Address - Street 1:4602 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0021
Mailing Address - Country:US
Mailing Address - Phone:906-225-3910
Mailing Address - Fax:906-225-4529
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 344
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-3910
Practice Address - Fax:906-225-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICB0539OtherRAILROAD MEDICARE
MICB9574OtherRAILROAD MEDICARE
MICA1145OtherRAILROAD MEDICARE
MI0E21002OtherBCBS GROUP
MI0E20995OtherBCBSM NEPHROLOGY GRP
MICB0539OtherRAILROAD MEDICARE
MI0M03300Medicare PIN
MICB9574OtherRAILROAD MEDICARE