Individual
DR. MARK W LAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
117 S BROADWAY ST, CASSOPOLIS, MI 49031-1242
(269) 445-0771
Mailing address
117 S BROADWAY ST, CASSOPOLIS, MI 49031-1242
(269) 445-0771
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
236771
NY
207Q00000X
Family Medicine Physician
31145
WI
207Q00000X
Family Medicine Physician
Primary
4301073557
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0803810311
BCBS IND PIN #
MI
01
—
LM073557
BCBS IND BILLING #
MI
Enumeration date
10/03/2005
Last updated
07/08/2007
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