Provider Demographics
NPI:1811078710
Name:JOSEPH E. MARK, MD PC
Entity type:Organization
Organization Name:JOSEPH E. MARK, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ELIOT
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-606-0000
Mailing Address - Street 1:1886 W AUBURN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3858
Mailing Address - Country:US
Mailing Address - Phone:248-606-0000
Mailing Address - Fax:248-606-0001
Practice Address - Street 1:1886 W AUBURN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3858
Practice Address - Country:US
Practice Address - Phone:248-606-0000
Practice Address - Fax:248-606-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI32166208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0630230Medicare ID - Type Unspecified
MIB-44895Medicare UPIN