Provider Demographics
NPI:1487663399
Name:HOCHSTETLER, MARK ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:HOCHSTETLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2821 EMERALD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2403
Mailing Address - Country:US
Mailing Address - Phone:260-459-1833
Mailing Address - Fax:260-459-2769
Practice Address - Street 1:2821 EMERALD LAKE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2403
Practice Address - Country:US
Practice Address - Phone:260-459-1833
Practice Address - Fax:260-459-2769
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01032333A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine