Provider Demographics
NPI:1093997884
Name:MARK D YOUNG DPM
Entity Type:Organization
Organization Name:MARK D YOUNG DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:989-772-3588
Mailing Address - Street 1:405 S MISSION ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2878
Mailing Address - Country:US
Mailing Address - Phone:989-772-3588
Mailing Address - Fax:989-772-0469
Practice Address - Street 1:405 S MISSION ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2878
Practice Address - Country:US
Practice Address - Phone:989-772-3588
Practice Address - Fax:989-772-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMY001144213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4853750000OtherBLUE CROSS BLUE SHIELD
MI4853750000OtherBLUE CROSS BLUE SHIELD
MI5375000Medicare PIN
T33983Medicare UPIN
MI4853750000OtherBLUE CROSS BLUE SHIELD