Provider Demographics
NPI:1851426811
Name:EAR, NOSE AND THROAT ASSOC OF MARQUETTE, P.C.
Entity Type:Organization
Organization Name:EAR, NOSE AND THROAT ASSOC OF MARQUETTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FOLKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-225-3920
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-3920
Mailing Address - Fax:906-225-4553
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-3920
Practice Address - Fax:906-225-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI073897207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4108826Medicaid
MI4108826Medicaid
MI0E26037Medicare ID - Type Unspecified