MEDICARE: MARK ALLEN ROLAIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	4301058346	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180046164	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0F37820	OTHER	MI	BLUE CROSS BLUE SHIELD MICHIGAN
3	4575228	OTHER	MI	AETNA PROVIDER ID

General Provider Information

NPI Number	:	1366481855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALLEN ROLAIN M.D.

Provider Business Mailing Address
First Line	:	44344 DEQUINDRE RD
Second Line	:	STE. 110
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-1038
Country	:	US
Telephone Number	:	586-884-5160
Fax Number	:	586-884-5165

Provider Business Practice Location Address
First Line	:	44344 DEQUINDRE RD
Second Line	:	STE. 110
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-1038
Country	:	US
Telephone Number	:	586-884-5160
Fax Number	:	586-884-5165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	10/30/2020

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Directions to “ MARK ALLEN ROLAIN M.D.” Practice Location

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