Provider Demographics
NPI:1285636639
Name:DUKAJ, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DUKAJ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:45640 SCHOENHERR RD
Mailing Address - Street 2:STE 150
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-6033
Mailing Address - Country:US
Mailing Address - Phone:586-566-3092
Mailing Address - Fax:586-566-3093
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:STE 150
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:313-886-8787
Practice Address - Fax:313-886-4103
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2016-06-14
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Provider Licenses
StateLicense IDTaxonomies
MIMD055760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F59496Medicare UPIN
OH26358-015Medicare ID - Type Unspecified