Provider Demographics
NPI:1457699266
Name:MARK D YOUNG DPM
Entity Type:Organization
Organization Name:MARK D YOUNG DPM
Other - Org Name:MARK D YOUNG DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:989-772-3588
Mailing Address - Street 1:225 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-3350
Mailing Address - Country:US
Mailing Address - Phone:989-832-5114
Mailing Address - Fax:989-832-0149
Practice Address - Street 1:225 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-3350
Practice Address - Country:US
Practice Address - Phone:989-832-5114
Practice Address - Fax:989-832-0149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK D YOUNG DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMY0011474213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093997884Medicare NSC