Provider Demographics
NPI:1982667002
Name:MASTROPAOLO, MARC S (DO)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:S
Last Name:MASTROPAOLO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:248-476-6465
Practice Address - Street 1:IHA HOSPITAL MEDICINE SERVICES
Practice Address - Street 2:5301 MCAULEY DRIVE
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-8676
Practice Address - Fax:248-476-6465
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2023-09-13
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Provider Licenses
StateLicense IDTaxonomies
MIMM009644207R00000X
MI5101009644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4691605Medicaid
MI124168OtherCARE CHOICES/PREF CHOICES
MI421561900OtherTAX ID
MI1156311905OtherBCBS
MI1156311905OtherBCBS
MIE77785Medicare UPIN