Provider Demographics
NPI:1700929411
Name:U. P. DIGESTIVE DISEASE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:U. P. DIGESTIVE DISEASE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIUBAKKA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:906-225-3880
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:STE 247
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-3880
Mailing Address - Fax:906-225-4523
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:STE 247
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-3880
Practice Address - Fax:906-225-4523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICK5977OtherRAILROAD MEDICARE
MI0N83900Medicare PIN