Provider Demographics
NPI:1568558229
Name:SLOANE, MARK ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:SLOANE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:7604 DUNROSS DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024
Mailing Address - Country:US
Mailing Address - Phone:269-327-6072
Mailing Address - Fax:
Practice Address - Street 1:700 MALL DR
Practice Address - Street 2:SUITE C
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1800
Practice Address - Country:US
Practice Address - Phone:269-373-1170
Practice Address - Fax:269-373-1154
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI51010082732080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics