Provider Demographics
NPI:1326005141
Name:MASLOVICH, MARK MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MICHAEL
Last Name:MASLOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:315 E WARWICK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1083
Mailing Address - Country:US
Mailing Address - Phone:989-466-5486
Mailing Address - Fax:989-466-2486
Practice Address - Street 1:315 E WARWICK DR
Practice Address - Street 2:SUITE D
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1083
Practice Address - Country:US
Practice Address - Phone:989-466-5486
Practice Address - Fax:989-466-5023
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMM063426207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1605900452OtherBCBSM PIN
MI200000005803OtherPHP COMMERCIAL
MI0985245OtherHEALTHPLUS COMMERCIAL
MI1006846OtherMCLAREN
MI104385209Medicaid
MI200000005803OtherPHP COMMERCIAL
MI104385209Medicaid
MIM17670015Medicare PIN