Healthcare Provider Details

I. General information

NPI: 1376768929
Provider Name (Legal Business Name): MR. MARK STEPHEN MEIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HURON AVE
PORT HURON MI
48060-3822
US

IV. Provider business mailing address

2876 HENRY ST UNIT 1
PORT HURON MI
48060-7365
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-9440
  • Fax:
Mailing address:
  • Phone: 810-824-0462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: