Dack, Marty Phillip

Dack, Marty Phillip is an individual health care provider with primary practice located at 1703 E Michigan Ave , Lansing MI 48912-2841. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Dack, Marty Phillip can be contacted via phone (517) 913-3860.

Contact Information

Primary practice address
1703 E Michigan Ave Lansing MI 48912-2841
Phone: (517) 913-3860
Fax: (517) 484-6864
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 4704222015 Michigan

Profile Details

NPI number 1871686337
LBN Legal business name Dack, Marty Phillip
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 2nd, 2006
Last updated Aug 26th, 2010 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871686337 NPPES
Michigan Other 1057822 MCLAREN HEALTH PLAN-COMMERCIAL
Michigan Other 200000006547 MCLAREN HEALTH PLAN-COMMERCIAL
Michigan MEDICAID 4950304 MCLAREN HEALTH PLAN-COMMERCIAL
Michigan Other 5008702500 MCLAREN HEALTH PLAN-COMMERCIAL
Michigan Other P00367059 MCLAREN HEALTH PLAN-COMMERCIAL
Michigan Other 1057822 MCLAREN HEALTH PLAN-COMMERCIAL
Michigan Other 1057822 MCLAREN HEALTH PLAN-COMMERCIAL
Michigan Other 7952506 MCLAREN HEALTH PLAN-COMMERCIAL
Michigan Other N55170013 MCLAREN HEALTH PLAN-COMMERCIAL
Michigan Other 200000006547 MCLAREN HEALTH PLAN-COMMERCIAL

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