Provider Demographics
NPI:1457531766
Name:MAPLE CITY FAMILY PRACTICE MARK
Entity Type:Organization
Organization Name:MAPLE CITY FAMILY PRACTICE MARK
Other - Org Name:MARK BIGLER, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-660-1717
Mailing Address - Street 1:85 BENEDICT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2112
Mailing Address - Country:US
Mailing Address - Phone:419-660-1717
Mailing Address - Fax:419-660-1718
Practice Address - Street 1:85 BENEDICT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2112
Practice Address - Country:US
Practice Address - Phone:419-660-1717
Practice Address - Fax:419-660-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2182132Medicaid
OHBI0895792Medicare PIN
OH2182132Medicaid
OHG64125Medicare UPIN