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General NPI Number Information
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NPI Number | 1659358661
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Entity Type | Individual
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Provider Name | MARK S MCCORMICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 601 JOHN ST M 475
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City | KALAMAZOO
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State | MI
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Zip | 49007-5341
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Country | US
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Telephone | 269-276-0000
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Fax | 269-276-0001
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Provider Business Mailing Address
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Address Line | 601 JOHN ST BOX 42
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City | KALAMAZOO
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State | MI
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Zip | 49007-5341
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Country | US
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Telephone | 269-341-8419
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Fax | 269-341-8743
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301046225
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License Number State | MI
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