Provider Demographics
NPI:1386174134
Name:MIDDEL, MARJORIE (MS W)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:MIDDEL
Suffix:
Gender:F
Credentials:MS W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALEDA E. LUTZ VETERANS AFFAIRS MEDICAL CENTER CADILLAC
Mailing Address - Street 2:1909 N. MITCHELL STREET
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601
Mailing Address - Country:US
Mailing Address - Phone:231-775-4401
Mailing Address - Fax:231-775-4546
Practice Address - Street 1:1909 N. MITCHELL STREET
Practice Address - Street 2:ALEDA E. LUTZ VETERANS AFFAIRS MEDICAL CENTER CADILLAC
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601
Practice Address - Country:US
Practice Address - Phone:231-775-4401
Practice Address - Fax:231-775-4546
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010171681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical