Dr. Mark Allen Grevious
Surgeon Plastic and Reconstructive Surgery
7905 Calumet Ave
Munster
, Indiana 46321-2549
Dr. Mark Allen Grevious
Surgeon Plastic and Reconstructive Surgery
7905 Calumet Ave
Munster
, Indiana 46321-2549
(317) 865-1479
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About
Features
Specialties
- Surgeon
- Plastic and Reconstructive Surgery
Languages spoken
- English
Location
First Address
- Dr. Mark Allen Grevious
- Po Box 781076
- Detroit, MI
- Zip : 48278-1076
- Fax : (317) 865-1479
- Phone : (317) 528-4800
Second Address
- Dr. Mark Allen Grevious
- 7905 Calumet Ave
- Munster, IN
- Zip : 46321-2549
- Fax : (219) 836-7515
- Phone : (219) 836-7506
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208200000X | Surgeon | 01060561A | IN |
| Y | 208600000X | Surgeon | 01060561A | IN |
| N | 208200000X | Surgeon | 036100551 | IL |
| N | 208600000X | Surgeon | 036100551 | IL |
| N | 208200000X | Surgeon | 01060561A | IN |
| N | 208600000X | Surgeon | 01060561A | IN |
| N | 2086S0122X | Plastic and Reconstructive Surgery | 036100551 | IL |
National Provider Identifier
| NPI | 1194727909 |
|---|---|
| Provider Name | Dr. Mark Allen Grevious |
| First Address | Detroit, MI 48278-1076 |
| Second Address | Munster, IN 46321-2549 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 11/08/2005 |
| Last Update Date | 26/04/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 036-100551-1 | (05) | IL |
| H40354 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.