Organization
CITY OF MARIETTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL K BROCKETT M.D. (HEALTH COMMISSIONER)
(740) 373-0611
Entity
Organization
Contact information
Practice address
304 PUTNAM ST, MARIETTA, OH 45750-3022
(740) 373-0611
(740) 376-2008
Mailing address
304 PUTNAM ST, MARIETTA, OH 45750-3022
(740) 373-0611
(740) 376-2008
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
35043094B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0515071
—
OH
Enumeration date
06/21/2006
Last updated
11/24/2014
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