Provider Demographics
NPI:1417038449
Name:SKORY, MARK LOUIS (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LOUIS
Last Name:SKORY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:312 E MIDLAND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUBURN
Mailing Address - State:MI
Mailing Address - Zip Code:48611-9751
Mailing Address - Country:US
Mailing Address - Phone:989-662-4425
Mailing Address - Fax:989-662-3343
Practice Address - Street 1:312 E MIDLAND RD
Practice Address - Street 2:SUITE A
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-9751
Practice Address - Country:US
Practice Address - Phone:989-662-4425
Practice Address - Fax:989-662-3343
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4441792OtherMI CONF OF TEAMSTERS
MI41S55216OtherHEALTH PLUS OF MI
MI170718 E33180OtherSELECTCARE
MI3246265Medicaid
MI0150900125OtherBLUE CARE NETWORK
MI170718 E33180OtherSELECTCARE
MIE33180Medicare UPIN