Provider Demographics
NPI:1245236058
Name:OHM, MARK EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:OHM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3290 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 444
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2917
Mailing Address - Country:US
Mailing Address - Phone:248-816-9200
Mailing Address - Fax:248-816-1017
Practice Address - Street 1:3290 W BIG BEAVER RD
Practice Address - Street 2:SUITE 444
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-2914
Practice Address - Country:US
Practice Address - Phone:248-816-9200
Practice Address - Fax:248-816-1017
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301071786207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M43750-001Medicare PIN
MI0M43750005Medicare PIN
MI063-46052OtherBCBS
MIM43750-005Medicare ID - Type Unspecified
MI14143OtherMCARE
MIH61335Medicare UPIN