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General NPI Number Information
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NPI Number | 1568558229
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Entity Type | Individual
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Provider Name | MARK ALAN SLOANE D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 700 MALL DR SUITE C
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City | PORTAGE
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State | MI
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Zip | 49024-1800
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Country | US
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Telephone | 269-373-1170
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Fax | 269-373-1154
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Provider Business Mailing Address
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Address Line | 7604 DUNROSS DRIVE
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City | PORTAGE
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State | MI
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Zip | 49024
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Country | US
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Telephone | 269-327-6072
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Fax |
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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 | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | 5101008273
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License Number State | MI
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