Individual
MARK INES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8348 WASHINGTON AVE, RACINE, WI 53406-3733
(262) 884-4000
Mailing address
8106 WHITETAIL DR, RACINE, WI 53406-1746
(262) 886-1687
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
48513
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34807700
—
WI
Enumeration date
01/09/2007
Last updated
07/08/2007
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