Individual
DR. MARK JEFFREY MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
29701 6 MILE RD, #100A, LIVONIA, MI 48152-8600
(734) 261-3808
(734) 261-3821
Mailing address
29701 6 MILE RD, #100A, LIVONIA, MI 48152-8600
(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
—
382334116
TAX ID
—
01
—
480045246
RAILROAD MEDICARE
MI
01
—
4858254620
BLUE CROSS
MI
Enumeration date
07/28/2006
Last updated
11/21/2013
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