Provider Demographics
NPI:1023184819
Name:GALAN, MARK V (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:V
Last Name:GALAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4100 PARK FOREST DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7331
Mailing Address - Country:US
Mailing Address - Phone:231-935-5710
Mailing Address - Fax:231-935-9045
Practice Address - Street 1:4100 PARK FOREST DR
Practice Address - Street 2:SUITE 208
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7331
Practice Address - Country:US
Practice Address - Phone:231-935-5710
Practice Address - Fax:231-935-9045
Is Sole Proprietor?:No
Enumeration Date:2006-11-26
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMG072049207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4596099Medicaid
MIOB81010OtherBCBSM
MIOB81010OtherBCBSM
MII07877Medicare UPIN