Provider Demographics
NPI:1942290507
Name:SCAPINI, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:SCAPINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:755 W BIG BEAVER RD
Practice Address - Street 2:SUITE 231
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4900
Practice Address - Country:US
Practice Address - Phone:248-362-2073
Practice Address - Fax:248-362-6157
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI06324081111OtherBCBS
06324081111Medicare ID - Type Unspecified
MI06324081111OtherBCBS