Provider Demographics
NPI:1962511097
Name:POMARANSKI, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:POMARANSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:550 MUNSON AVE, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686
Mailing Address - Country:US
Mailing Address - Phone:231-935-8717
Mailing Address - Fax:231-935-9230
Practice Address - Street 1:550 MUNSON AVE, SUITE 200
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686
Practice Address - Country:US
Practice Address - Phone:231-935-8717
Practice Address - Fax:231-935-9230
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010676697207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-2170687OtherPRIORITY HEALTH
MI0702810641OtherBLUE CROSS BLUE SHIELD
MIP00271718OtherRAILROAD MEDICARE
MIM008816OtherTRICARE
MIP00271718OtherRAILROAD MEDICARE
MIM008816OtherTRICARE