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NPI Code Detail

MEDICARE: DR. DAVID G MARK MD

MEDICARE: DR. DAVID G MARK MD
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
1207RG0100XGastroenterology Physician01037623AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5110082367OTHERINRAIL ROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12004184004OTHERINCIGNA
2000000084424OTHERINBLUECROSS BLUESHIELD
34229217OTHERINAETNA
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770587339
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID G MARK MD
Provider Business Mailing Address
First Line : 10466 WOODCHUCK CT
Second Line :
City : GRANGER
State : IN
Zip : 46530-6029
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 17501 GENERATIONS DR
Second Line :
City : SOUTH BEND
State : IN
Zip : 46635-1589
Country : US
Telephone Number : 574-000-0000
Fax Number : 574-000-0000
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 05/19/2016

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Directions to “ DR. DAVID G MARK MD” Practice Location

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