Healthcare Provider Details

I. General information

NPI: 1922392018
Provider Name (Legal Business Name): MARK R MCMURRAY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4048 CEDAR BLUFF DR SUITE 1
PETOSKEY MI
49770-8895
US

IV. Provider business mailing address

4048 CEDAR BLUFF DR SUITE 1
PETOSKEY MI
49770-8895
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-5155
  • Fax: 231-347-6128
Mailing address:
  • Phone: 231-347-5155
  • Fax: 231-347-6128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4301049090
License Number StateMI

VIII. Authorized Official

Name: MARK R MCMURRAY
Title or Position: PRESIDENT
Credential: MD
Phone: 231-347-5155