Individual
MARK S SANDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 EAST BLVD, ADMINISTRATION, ELKHART, IN 46514-2483
(574) 296-2925
(574) 523-3495
Mailing address
600 EAST BLVD, ADMINISTRATION, ELKHART, IN 46514-2483
(574) 296-2925
(574) 523-3495
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01024361
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000215929
BCBS
IN
01
—
021236800
FEDERAL BLACK LUNG
IN
05
—
100220640A
—
IN
Enumeration date
06/12/2006
Last updated
01/04/2010
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