Individual
DR. MARK A DITTENBIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 JOHN ST STE M283A, KALAMAZOO, MI 49007-5341
(269) 349-7696
(269) 488-8313
Mailing address
601 JOHN ST, SUITE M283A, KALAMAZOO, MI 49007-5341
(269) 349-7696
(269) 488-8313
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301048692
MI
2086S0129X
Vascular Surgery Physician
4301048692
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020C91020
BCBS GRP PIN
MI
01
—
116658
GREAT LAKES HLTH PLN
—
01
—
1417961137
BCBSM - BRONSON
MI
05
—
1942249727
—
MI
05
—
3218986-10
—
MI
01
—
3403901640
BCBS IND PIN
MI
01
—
5515041
AETNA PIN
—
Enumeration date
06/06/2006
Last updated
05/01/2018
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