Provider Demographics
NPI:1366481855
Name:ROLAIN, MARK ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:ROLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:44344 DEQUINDRE RD
Mailing Address - Street 2:STE. 110
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1038
Mailing Address - Country:US
Mailing Address - Phone:586-884-5160
Mailing Address - Fax:586-884-5165
Practice Address - Street 1:44344 DEQUINDRE RD
Practice Address - Street 2:STE. 110
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1038
Practice Address - Country:US
Practice Address - Phone:586-884-5160
Practice Address - Fax:586-884-5165
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301058346207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180046164OtherRAILROAD MEDICARE
MI0F37820OtherBLUE CROSS BLUE SHIELD MICHIGAN
MI4575228OtherAETNA PROVIDER ID
180046164OtherRAILROAD MEDICARE
MIE62062Medicare UPIN
MI0N62910Medicare ID - Type Unspecified
MI4681960001Medicare NSC
MIP37820001Medicare PIN