Individual
DR. PAUL MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25 MICHIGAN ST NE, SUITE 2000, GRAND RAPIDS, MI 49503-2515
(616) 391-2192
(616) 391-3114
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
4301057958
MI
207V00000X
Obstetrics & Gynecology Physician
01040767A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831137629
—
MI
05
—
200056530A
—
IN
Enumeration date
06/03/2006
Last updated
02/26/2021
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