Individual
MARK MARSHALL MILLAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1179 E PARIS AVE SE, SUITE 150, GRAND RAPIDS, MI 49546-8371
(616) 957-1912
(616) 957-0074
Mailing address
1179 E PARIS AVE SE, SUITE 150, GRAND RAPIDS, MI 49546-8371
(616) 957-1912
(616) 957-0074
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
4301071401
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
347887810
—
MI
Enumeration date
04/16/2007
Last updated
05/14/2014
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