Provider Demographics
NPI:1194843508
Name:DZWIK, MARK JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:DZWIK
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 1:200 APPLE BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7631
Mailing Address - Country:US
Mailing Address - Phone:269-966-4502
Mailing Address - Fax:
Practice Address - Street 1:200 APPLE BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7631
Practice Address - Country:US
Practice Address - Phone:269-966-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084361207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0101311892OtherBCBS MICHIGAN/BATTLECREEK
MIC96159120Medicare PIN
MI125 S. KALAMAZOO MALMedicare PIN
MIP00463587Medicare PIN
MI0101311892OtherBCBS MICHIGAN/BATTLECREEK
MII71792Medicare UPIN