Provider Demographics
NPI:1932455433
Name:DLP MARQUETTE PHYSICIAN PRACTICES INC
Entity Type:Organization
Organization Name:DLP MARQUETTE PHYSICIAN PRACTICES INC
Other - Org Name:HANCOCK MARQUETTE GENERAL NEUROLOGY - COOPER COUNTRY
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 1:500 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1569
Mailing Address - Country:US
Mailing Address - Phone:906-483-1730
Mailing Address - Fax:906-483-1270
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1569
Practice Address - Country:US
Practice Address - Phone:906-483-1730
Practice Address - Fax:906-483-1270
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DLP MARQUETTE PHYSICIAN PRACTICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty