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Individual

MARK A. SQUIRE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
HENRY FORD HEALTH SYSTEM, 29200 SCHOOLCRAFT, LIVONIA, MI 48150
(734) 523-1050
(734) 523-2464
Mailing address
HENRY FORD HEALTH SYSTEM, 29200 SCHOOLCRAFT, LIVONIA, MI 48150
(734) 523-1050

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5901000917
MI
213ES0103X
Foot & Ankle Surgery Podiatrist
5901000917
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
462104813
MI
01
480H280180
BLUE CROSS-BLUE CROSS
01
MS000917
COMMERCIAL-COMMERCIAL NUMBER
Enumeration date
08/14/2006
Last updated
03/08/2021
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