Individual
JULIE P. MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1627 E BRISTOL ST, ELKHART, IN 46514-3817
(574) 262-0313
(574) 262-8163
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01036572A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000924711
BCBS BMG PEDIATRICS
IN
05
—
100130050
—
IN
Enumeration date
01/28/2015
Last updated
03/18/2016
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