Individual
DR. MARK A MUCKWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
611 E DOUGLAS RD STE 305, MISHAWAKA, IN 46545-1467
(574) 335-6450
(574) 335-0643
Mailing address
707 CEDAR ST STE 405, SOUTH BEND, IN 46617-2059
(574) 335-8707
(574) 335-0741
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01039796A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102409327
ANTHEM
IN
05
—
200020160
—
IN
Enumeration date
10/12/2006
Last updated
12/12/2025
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