Provider Demographics
NPI:1437228301
Name:MARK A PRIEST DO PC
Entity Type:Organization
Organization Name:MARK A PRIEST DO PC
Other - Org Name:LEELANAU FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-271-5161
Mailing Address - Street 1:650 S WEST BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9587
Mailing Address - Country:US
Mailing Address - Phone:231-271-5161
Mailing Address - Fax:231-271-3590
Practice Address - Street 1:650 S WEST BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-9587
Practice Address - Country:US
Practice Address - Phone:231-271-5161
Practice Address - Fax:231-271-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P04820Medicare ID - Type Unspecified