Organization
MARK J. MOSS DPM P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK J MOSS DPM (OWNER)
(734) 261-3808
Entity
Organization
Contact information
Practice address
29701 6 MILE RD STE 100A, LIVONIA, MI 48152-8601
(734) 261-3808
(734) 261-3821
Mailing address
29701 6 MILE RD STE 100A, LIVONIA, MI 48152-8601
(734) 261-3808
(734) 261-3821
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5901000715
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1352311
—
MI
01
—
4858254620
BLUE CROSS
MI
Enumeration date
09/29/2009
Last updated
11/21/2013
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