Individual
DR. MARK FAVOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-1553
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-1553
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4301092115
MI
282N00000X
General Acute Care Hospital
Primary
207N00000X
MI
Other
Enumeration date
06/21/2010
Last updated
07/17/2019
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