=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205922044
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK DANIEL SAUNDERS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 01/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3950 SHORE RD
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-938-7004
-----------------------------------------------------
Fax | 231-938-3112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3950 SHORE RD
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-938-7004
-----------------------------------------------------
Fax | 231-938-3112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | MS051504
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------