Funtanilla, Marjorie V
Funtanilla, Marjorie V is an individual health care provider with primary practice located at 1711 S Stephenson Ave Suite 225, Iron Mountain MI 49801-3639. She recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as her primary health care specialty. Funtanilla, Marjorie V can be contacted via phone (906) 776-5860.Contact Information
Primary practice address
1711 S Stephenson Ave Suite 225
Iron Mountain MI 49801-3639
Phone: (906) 776-5860
Fax: (906) 776-5833
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | 4301071282 | Michigan |
Profile Details
| NPI number | 1730161555 |
|---|---|
| LBN Legal business name | Funtanilla, Marjorie V |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 17th, 2005 |
| Last updated | Jul 10th, 2012 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1730161555 | NPPES |
| Minnesota | Other | 110191045 | RR MEDICARE |
| Minnesota | Other | 1102200711 | RR MEDICARE |
| Minnesota | MEDICAID | 32482700 | RR MEDICARE |
| Minnesota | MEDICAID | 3498057 | RR MEDICARE |
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