Provider Demographics
NPI:1487631180
Name:HNATIUK, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:HNATIUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26850 PROVIDENCE PARKWAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1252
Mailing Address - Country:US
Mailing Address - Phone:248-465-5314
Mailing Address - Fax:248-465-5301
Practice Address - Street 1:26850 PROVIDENCE PARKWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1252
Practice Address - Country:US
Practice Address - Phone:248-465-5314
Practice Address - Fax:248-465-5301
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074049207Y00000X
MI430107409207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH389063649-00OtherBWC
I44108Medicare UPIN