Provider Demographics
NPI:1376510099
Name:SCHURY, MARK PETER (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PETER
Last Name:SCHURY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4400 DIXIE HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3508
Mailing Address - Country:US
Mailing Address - Phone:248-673-1244
Mailing Address - Fax:248-673-0114
Practice Address - Street 1:4400 DIXIE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3508
Practice Address - Country:US
Practice Address - Phone:248-673-1244
Practice Address - Fax:248-673-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS013623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0856306175OtherBCBSM
MI0856306175OtherBCBSM
MIOM99680Medicare ID - Type Unspecified