MEDICARE: DR. MARK J SCAPINI 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
1	207R00000X	Internal Medicine Physician	4301046111	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06324081111	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1942290507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J SCAPINI MD

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 W BIG BEAVER RD
Second Line	:	SUITE 231
City	:	TROY
State	:	MI
Zip	:	48084-4900
Country	:	US
Telephone Number	:	248-362-2073
Fax Number	:	248-362-6157

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	10/22/2020

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