MEDICARE: DR. MARK JAMES IVEY 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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	4301407127	MI
2	207RP1001X	Pulmonary Disease Physician	4301407127	MI
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	4301407127	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1417961137	OTHER	MI	BCBS BRONSON
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962450981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK JAMES IVEY M.D.

Provider Business Mailing Address
First Line	:	17357 VAN WAGONER RD
Second Line	:	SUITE 2
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9702
Country	:	US
Telephone Number	:	616-847-1009
Fax Number	:	616-847-1607

Provider Business Practice Location Address
First Line	:	17357 VAN WAGONER RD
Second Line	:	SUITE 2
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9702
Country	:	US
Telephone Number	:	616-847-1009
Fax Number	:	616-847-1607

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/19/2012

Similar Medicare Providers

1902880073 — DR. LEVI J PULVER DC
Practice Location Address:

17208 VANWAGONER
SPRING LAKE, MI
49456-9702

Practice Phone: 616-834-3330
Practice Fax: 616-935-0748

1700863370 — MR. ROBIN ISAACS PT
Practice Location Address:

17210 VAN WAGONER RD
SPRING LAKE, MI
49456-9702

Practice Phone: 616-402-3419
Practice Fax: 616-935-3535

1245283696 — LAKE SHORE PULMONOLOGY, PLC
Practice Location Address:

17357 VAN WAGONER RD , SUITE 2
SPRING LAKE, MI
49456-9702

Practice Phone: 616-847-1009
Practice Fax: 616-847-1607

1336188556 — KATHERINE ANN JAWOR D.O.
Practice Location Address:

17325 VAN WAGONER RD
SPRING LAKE, MI
49456-9702

Practice Phone: 616-364-1500
Practice Fax: 616-364-6400

1235152158 — NORBERT PAUL GERONDALE M.D.
Practice Location Address:

17210 VAN WAGONER RD
SPRING LAKE, MI
49456-9702

Practice Phone: 616-604-6040
Practice Fax: 616-604-6046

1811903321 — DEREK L BURT NP
Practice Location Address:

17325 VAN WAGONER RD
SPRING LAKE, MI
49456-9702

Practice Phone: 616-847-5145
Practice Fax:

Directions to “ DR. MARK JAMES IVEY M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.