Provider Demographics
NPI:1205922044
Name:SAUNDERS, MARK DANIEL (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:DANIEL
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690
Mailing Address - Country:US
Mailing Address - Phone:231-938-7004
Mailing Address - Fax:231-938-3112
Practice Address - Street 1:3950 SHORE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690
Practice Address - Country:US
Practice Address - Phone:231-938-7004
Practice Address - Fax:231-938-3112
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS051504207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
070015914OtherRR MEDICARE
OP17580Medicare ID - Type Unspecified
070015914OtherRR MEDICARE