Provider Demographics
NPI:1952658593
Name:DLP MARQUETTE PHYSICIAN PRACTICES INC
Entity Type:Organization
Organization Name:DLP MARQUETTE PHYSICIAN PRACTICES INC
Other - Org Name:MARQUETTE GENERAL DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:STE 242
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-7920
Mailing Address - Fax:906-225-4969
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:STE 242
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-7920
Practice Address - Fax:906-225-4969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DLP MARQUETTE PHYSICIAN PRACTICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty