Provider Demographics
NPI:1568722817
Name:MARK 5 CARE GROUP, PLLC
Entity Type:Organization
Organization Name:MARK 5 CARE GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-830-6673
Mailing Address - Street 1:9801 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-9531
Mailing Address - Country:US
Mailing Address - Phone:405-830-6673
Mailing Address - Fax:
Practice Address - Street 1:1407 N ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-4823
Practice Address - Country:US
Practice Address - Phone:405-232-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty