Healthcare Provider Details

I. General information

NPI: 1619304490
Provider Name (Legal Business Name): MARK HNATIUK MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15120 MICHIGAN AVE
DEARBORN MI
48126-2916
US

IV. Provider business mailing address

15120 MICHIGAN AVE
DEARBORN MI
48126-2916
US

V. Phone/Fax

Practice location:
  • Phone: 734-812-7415
  • Fax: 734-212-2125
Mailing address:
  • Phone: 734-812-7415
  • Fax: 734-212-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK HNATIUK
Title or Position: M.D./OWNER
Credential: M.D.
Phone: 734-812-7415