Individual
JOHN MACKOVJAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1535 E BROOMFIELD ST, MT PLEASANT, MI 48858-4489
(989) 772-3339
(989) 772-4846
Mailing address
2001 COOLIDGE RD, EAST LANSING, MI 48823-1378
(517) 337-0316
(517) 337-1779
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301099081
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301099081
STATE LICENSE
MI
Enumeration date
07/18/2011
Last updated
08/16/2023
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