Provider Demographics
NPI:1629068614
Name:FOLTS, MARK
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:FOLTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8434 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-1190
Mailing Address - Country:US
Mailing Address - Phone:810-686-1997
Mailing Address - Fax:810-686-1820
Practice Address - Street 1:8434 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-1190
Practice Address - Country:US
Practice Address - Phone:810-686-1997
Practice Address - Fax:810-686-1820
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704110505363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4754198Medicaid
MIP21430002Medicare PIN
S22417Medicare UPIN