Provider Demographics
NPI:1851529978
Name:MCINTEE, MARK BRIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BRIAN
Last Name:MCINTEE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 NORWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2424
Mailing Address - Country:US
Mailing Address - Phone:734-675-0736
Mailing Address - Fax:
Practice Address - Street 1:7575 W. GRAND RIVER
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114
Practice Address - Country:US
Practice Address - Phone:810-844-7518
Practice Address - Fax:810-844-7512
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005543363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical