Provider Demographics
NPI:1134301484
Name:MARK E GINTHER M D P C
Entity Type:Organization
Organization Name:MARK E GINTHER M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:GINTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-893-9705
Mailing Address - Street 1:200 S WENONA ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-8820
Mailing Address - Country:US
Mailing Address - Phone:989-893-9705
Mailing Address - Fax:
Practice Address - Street 1:200 S WENONA ST
Practice Address - Street 2:SUITE 225
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8820
Practice Address - Country:US
Practice Address - Phone:989-893-9705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301405779207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110090143OtherBCBSM
110210595OtherUNITED HEALTHCARE
19380OtherCOMMUNITY CHOICE
110090143OtherFEP BCBSM
4115699OtherAETNA
0090143OtherBLUE CARE NETWORK
0990164OtherHEALTH PLUS OF MI
110090143OtherBCBSM
4115699OtherAETNA