Provider Demographics
NPI:1487655882
Name:BISIGNANI, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BISIGNANI
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 1:1165 S DORA ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-8325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1165 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-8325
Practice Address - Country:US
Practice Address - Phone:707-463-3636
Practice Address - Fax:707-463-2714
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN385992085R0001X
CAG1512232085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN18A02BUOtherBLUE CROSS/SHIELD
MN2400131OtherMEDICA PRIMARY
MN2400132OtherMEDICA
MN32628800Medicaid
MN112202OtherUCARE
MN26712OtherAMERICA'S PPO
MN108453OtherCHOICE PLUS
MN963071012227OtherPREFERRED ONE
MNHP19060OtherHEALTH PARTNERS
MN001219000Medicaid