Provider Demographics
NPI:1780784991
Name:WARNER, MARK W (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:WARNER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:551 LINN ST
Mailing Address - Street 2:STE 220
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1595
Mailing Address - Country:US
Mailing Address - Phone:269-673-5571
Mailing Address - Fax:269-673-1654
Practice Address - Street 1:551 LINN ST
Practice Address - Street 2:STE 220
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1595
Practice Address - Country:US
Practice Address - Phone:269-673-5571
Practice Address - Fax:269-673-1654
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIMW007555207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11154701Medicaid
MIE26433Medicare UPIN
MI11154701Medicaid