Healthcare Provider Details

I. General information

NPI: 1629068614
Provider Name (Legal Business Name): MR. MARK FOLTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5154 MILLER RD STE 1
FLINT MI
48507-1065
US

IV. Provider business mailing address

5154 MILLER RD STE 1
FLINT MI
48507-1065
US

V. Phone/Fax

Practice location:
  • Phone: 810-228-3164
  • Fax: 949-437-2563
Mailing address:
  • Phone: 810-228-3164
  • Fax: 949-437-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704110505
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: