Provider Demographics
NPI:1447284112
Name:PERE MARQUETTE EMERGENCY PHYSICIANS, PLC
Entity type:Organization
Organization Name:PERE MARQUETTE EMERGENCY PHYSICIANS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CRANICK-KUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-845-2390
Mailing Address - Street 1:PO BOX 8309
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8309
Mailing Address - Country:US
Mailing Address - Phone:800-811-6964
Mailing Address - Fax:562-468-0347
Practice Address - Street 1:1 N ATKINSON DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1906
Practice Address - Country:US
Practice Address - Phone:231-845-2390
Practice Address - Fax:231-845-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD8294OtherRAILROAD MEDICARE
MI700E310200OtherBCBS
MI700E310200OtherBCBS
MI0P17700Medicare PIN