Provider Demographics
NPI:1932104882
Name:ARMSTRONG, MARK W (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2111 12 MILE RD NW
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-9754
Practice Address - Country:US
Practice Address - Phone:616-391-8470
Practice Address - Fax:616-391-8495
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3072667Medicaid
MI3072667Medicaid
MIOD16321006Medicare ID - Type Unspecified