Provider Demographics
NPI:1366646812
Name:MARK SCHARE PC
Entity Type:Organization
Organization Name:MARK SCHARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-822-6200
Mailing Address - Street 1:1777 AXTELL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4404
Mailing Address - Country:US
Mailing Address - Phone:248-822-6200
Mailing Address - Fax:248-822-6100
Practice Address - Street 1:1777 AXTELL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4404
Practice Address - Country:US
Practice Address - Phone:248-822-6200
Practice Address - Fax:248-822-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043733207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMS043733OtherMEDICAID LICENSE
MIMS043733OtherMEDICAID LICENSE
MI=========OtherTAX IDENTIFICATION
MIB48492Medicare UPIN
MI0P29320Medicare ID - Type Unspecified