Healthcare Provider Details

I. General information

NPI: 1154506731
Provider Name (Legal Business Name): MARK C MERING PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8145 VALLEYWOOD LN
PORTAGE MI
49024-5296
US

IV. Provider business mailing address

22528 VINEYARD CIR
MATTAWAN MI
49071-8504
US

V. Phone/Fax

Practice location:
  • Phone: 313-477-7553
  • Fax:
Mailing address:
  • Phone: 352-339-5267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013137
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: