Healthcare Provider Details

I. General information

NPI: 1629028634
Provider Name (Legal Business Name): MARK B SAFFER
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 SCHAEFER RD
DEARBORN MI
48126-3249
US

IV. Provider business mailing address

3165 GILBERT RIDGE DR
W BLOOMFIELD MI
48322-1836
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-2600
  • Fax: 313-581-0228
Mailing address:
  • Phone: 248-626-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901000555
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: