Provider Demographics
NPI:1285754101
Name:PETERS-SPARLING, MARTI J (MD)
Entity type:Individual
Prefix:
First Name:MARTI
Middle Name:J
Last Name:PETERS-SPARLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M 020
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-8282
Mailing Address - Fax:269-341-8258
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M020
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-8282
Practice Address - Fax:269-341-8258
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301084217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5178709Medicaid
MI5178880Medicaid
MI080C910950OtherBCBSM
MI1285754101Medicaid
MIM20520076Medicare PIN
MIA36090042Medicare PIN