Provider Demographics
NPI:1033229950
Name:FOLKENING, MARK NORVAL (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:NORVAL
Last Name:FOLKENING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2250
Mailing Address - Country:US
Mailing Address - Phone:616-502-7144
Mailing Address - Fax:616-786-0185
Practice Address - Street 1:111 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2250
Practice Address - Country:US
Practice Address - Phone:616-502-7144
Practice Address - Fax:616-786-0185
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMF031213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B43341Medicare UPIN
MIP14550001Medicare ID - Type Unspecified