Provider Demographics
NPI:1619304490
Name:MARK HNATIUK MD PLC
Entity Type:Organization
Organization Name:MARK HNATIUK MD PLC
Other - Org Name:CRANIOFACIAL INSTITUTE OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HNATIUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-812-7415
Mailing Address - Street 1:15120 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2916
Mailing Address - Country:US
Mailing Address - Phone:734-812-7415
Mailing Address - Fax:734-212-2125
Practice Address - Street 1:15120 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2916
Practice Address - Country:US
Practice Address - Phone:734-812-7415
Practice Address - Fax:734-212-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty