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General NPI Number Information
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NPI Number | 1285636639
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Entity Type | Individual
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Provider Name | MARK DUKAJ MD
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Gender | Male
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 22201 MOROSS RD STE 150
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City | DETROIT
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State | MI
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Zip | 48236-2169
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Country | US
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Telephone | 313-886-8787
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Fax | 313-886-4103
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Provider Business Mailing Address
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Address Line | 45640 SCHOENHERR RD STE 150
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-6033
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Country | US
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Telephone | 586-566-3092
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Fax | 586-566-3093
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD055760
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License Number State | MI
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