| Doctor Name: | RICHARD MARK |
| NPI Number: | 1649244286 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 5101009615 |
| Business Practice Address: | 9398 N Lilley Rd Plymouth, MI - 481704610 |
| Business Phone Number: | 7342540453 |
| Business Fax Number: | 7344591855 |
| Mailing Address: | 9398 N Lilley Rd, PLYMOUTH |
| State: | MI |
| Postal Code: | 481704610 |
| Phone Number: | 7342540453 |
| Fax Number: | 7344591855 |
| NPI Enumeration Date: | 02/13/2006 |
| NPI Last Update Date: | 02/18/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5101009615 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |