Provider Demographics
NPI:1376517987
Name:FIREMAN, MARK JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:FIREMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:ROYLE
Other - Last Name:FIREMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1901 STAR BATT DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3712
Mailing Address - Country:US
Mailing Address - Phone:248-844-4000
Mailing Address - Fax:248-844-4072
Practice Address - Street 1:1901 STAR BATT DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3712
Practice Address - Country:US
Practice Address - Phone:248-844-4000
Practice Address - Fax:248-844-4072
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME711802085R0001X
MI43010670422085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1824100Medicaid
FLCT399ZMedicare PIN
MIF27500Medicare UPIN