Individual
DR. MARK JAMES IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17357 VAN WAGONER RD, SUITE 2, SPRING LAKE, MI 49456-9702
(616) 847-1009
(616) 847-1607
Mailing address
17357 VAN WAGONER RD, SUITE 2, SPRING LAKE, MI 49456-9702
(616) 847-1009
(616) 847-1607
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
4301407127
MI
207RP1001X
Pulmonary Disease Physician
Primary
4301407127
MI
207RS0012X
Sleep Medicine (Internal Medicine) Physician
4301407127
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417961137
BCBS BRONSON
MI
05
—
1962450981
—
MI
05
—
476475710
—
MI
Enumeration date
05/04/2006
Last updated
07/19/2012
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