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NPI Code Detail

MEDICARE: MR. MARK ROBERT LOUSH LMSW

MEDICARE: MR. MARK ROBERT LOUSH LMSW
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
1104100000XSocial Worker6801059250MI

General Provider Information

NPI Number : 1871556803
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK ROBERT LOUSH LMSW
Provider Business Mailing Address
First Line : 3107 GOLDENEYE LN
Second Line :
City : WOLVERINE LAKE
State : MI
Zip : 48390-5458
Country : US
Telephone Number : 248-420-0832
Fax Number :
Provider Business Practice Location Address
First Line : 12851 GRAND RIVER RD
Second Line :
City : BRIGHTON
State : MI
Zip : 48116-8506
Country : US
Telephone Number : 800-529-7220
Fax Number : 810-220-5521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2006
Last Update Date : 09/04/2012

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