Provider Demographics
NPI:1225084262
Name:MACHALKA, MARK Z (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:Z
Last Name:MACHALKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1174 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1497
Mailing Address - Country:US
Mailing Address - Phone:269-781-9867
Mailing Address - Fax:269-781-9126
Practice Address - Street 1:1174 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1497
Practice Address - Country:US
Practice Address - Phone:269-781-9867
Practice Address - Fax:269-781-9126
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301083608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4635811Medicaid
MI4635811Medicaid
MIOA36038007Medicare ID - Type Unspecified