Healthcare Provider Details

I. General information

NPI: 1730305566
Provider Name (Legal Business Name): MARK ALAN NUGENT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21107 EUREKA RD
TAYLOR MI
48180-5232
US

IV. Provider business mailing address

2858 LESLIE PARK CIR
ANN ARBOR MI
48105-9254
US

V. Phone/Fax

Practice location:
  • Phone: 734-287-3415
  • Fax:
Mailing address:
  • Phone: 734-218-2133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number4301053131
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: