Organization
MEDICAL ACNE & SKIN CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE MATTILA (OFFICE MANAGER)
(906) 235-4486
Entity
Organization
Contact information
Practice address
150 W. RIDGE ST., MARQUETTE, MI 49855
(906) 235-4486
(906) 680-4077
Mailing address
150 W. RIDGE ST., MARQUETTE, MI 49855
(906) 235-4486
(906) 680-4077
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301066449
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4117988
—
MI
Enumeration date
05/15/2012
Last updated
12/22/2022
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