Healthcare Provider Details

I. General information

NPI: 1205922044
Provider Name (Legal Business Name): MARK DANIEL SAUNDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 SHORE RD
WILLIAMSBURG MI
49690
US

IV. Provider business mailing address

3950 SHORE RD
WILLIAMSBURG MI
49690
US

V. Phone/Fax

Practice location:
  • Phone: 231-938-7004
  • Fax: 231-938-3112
Mailing address:
  • Phone: 231-938-7004
  • Fax: 231-938-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMS051504
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: