Individual
MARK EDWARD SISSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8180 19 MILE RD, SAND LAKE, MI 49343-9455
(616) 696-2304
(616) 696-1713
Mailing address
8180 19 MILE RD, SAND LAKE, MI 49343-9455
(616) 696-2304
(616) 696-1713
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
AL410007118
MI
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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