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NPI Code Detail

MEDICARE: MARK HALVORSEN

MEDICARE: MARK HALVORSEN
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
11041C0700XClinical Social Worker6801058066MI

General Provider Information

NPI Number : 1730469008
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK HALVORSEN
Provider Business Mailing Address
First Line : 125 N LAKE ST
Second Line :
City : MANISTIQUE
State : MI
Zip : 49854-1234
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 114 W ELLIOTT ST
Second Line :
City : SAINT IGNACE
State : MI
Zip : 49781-1868
Country : US
Telephone Number : 906-643-8616
Fax Number : 906-643-7194
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2011
Last Update Date : 08/18/2011

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Directions to “ MARK HALVORSEN ” Practice Location

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