Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 18495 | MI |
Y | 213EG0000X | General Practice | 18495 | MI |
NPI | 1003865221 |
---|---|
Provider Name | Mr. Mark Steven Devuyst |
First Address | Shelby Twp, MI 48315-1759 |
Second Address | Clinton Township, MI 48038-5027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2006 |
Last Update Date | 23/11/2015 |