Provider Demographics
NPI:1932163276
Name:FLOREK, MARK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:FLOREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:42557 WOODWARD AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5206
Mailing Address - Country:US
Mailing Address - Phone:248-253-1608
Mailing Address - Fax:248-253-1660
Practice Address - Street 1:42557 WOODWARD AVE STE 210
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5206
Practice Address - Country:US
Practice Address - Phone:248-253-1608
Practice Address - Fax:248-253-1660
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB43467OtherHAP
MI4696890-10Medicaid
MI1962478743OtherCOMMERCIAL
MI700F37550OtherBCBSM
MI700F37550OtherBCN
MIM89900034Medicare ID - Type Unspecified
MI700F37550OtherBCBSM