Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | MY001144 | MI |
Y | 222Z00000X | Podiatrist | MY001144 | MI |
NPI | 1043247976 |
---|---|
Provider Name | Dr. Mark D Young |
First Address | Mt Pleasant, MI 48858 |
Second Address | Mt Pleasant, MI 48858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 07/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4853750000 | BCBS (01) | MI |
T33983 | (02) |