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General NPI Number Information
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NPI Number | 1093997884
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Entity Type | Organization
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Legal Business Name | MARK D YOUNG DPM
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 405 S MISSION ST SUITE 2
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City | MT PLEASANT
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State | MI
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Zip | 48858-2878
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Country | US
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Telephone | 989-772-3588
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Fax | 989-772-0469
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Provider Business Mailing Address
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Address Line | 405 S MISSION ST SUITE 2
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City | MT PLEASANT
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State | MI
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Zip | 48858-2878
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Country | US
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Telephone | 989-772-3588
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Fax | 989-772-0469
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Authorized Official
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Title or Position | PODIATRY
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Name | DR. MARK D YOUNG
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Credential | DPM
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Telephone | 989-772-3588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | MY001144
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License Number State | MI
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