Provider Demographics
NPI:1104874049
Name:DELANO, MARK C (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:DELANO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3264 N EVERGREEN DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9746
Mailing Address - Country:US
Mailing Address - Phone:616-363-7339
Mailing Address - Fax:616-361-5828
Practice Address - Street 1:3220 DISCOVERY DR STE 100
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-8609
Practice Address - Country:US
Practice Address - Phone:517-975-3794
Practice Address - Fax:517-975-8923
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-02-27
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Provider Licenses
StateLicense IDTaxonomies
MI43010673672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3251514Medicaid
MIC36350018Medicare ID - Type Unspecified
MI3251514Medicaid