Provider Demographics
NPI:1588808448
Name:VALASEK, MARK ANDREW (MD PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:VALASEK
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:3201 UNIVERSITY DR E STE 330
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3484
Practice Address - Country:US
Practice Address - Phone:979-321-6290
Practice Address - Fax:979-774-1253
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA127165207ZP0102X
390200000X
WAML 60097209207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology