Healthcare Provider Details

I. General information

NPI: 1386848752
Provider Name (Legal Business Name): BRIAN JEFFREY MARKLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44555 WOODWARD AVE SUITE 304
PONTIAC MI
48341-5031
US

IV. Provider business mailing address

44555 WOODWARD AVE SUITE 304
PONTIAC MI
48341-5031
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-3878
  • Fax: 248-209-6777
Mailing address:
  • Phone: 248-858-3878
  • Fax: 248-209-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125-050265
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301091849
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: