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Individual

CRAIG T MARKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
11141 PARKVIEW PLAZA DR STE 305, FORT WAYNE, IN 46845-1715
(260) 484-9611
(260) 484-1004
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01040928A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0116627
OH
01
020026958
MEDICARE RAILROAD
IN
05
100337150
IN
05
103421786
MI
Enumeration date
08/04/2005
Last updated
10/03/2022
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