Provider Demographics
NPI:1427090448
Name:ADAMS, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 MACKINAW RD
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9515
Mailing Address - Country:US
Mailing Address - Phone:989-753-4000
Mailing Address - Fax:989-754-4000
Practice Address - Street 1:5400 MACKINAW RD
Practice Address - Street 2:SUITE 2300
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9515
Practice Address - Country:US
Practice Address - Phone:989-753-4000
Practice Address - Fax:989-754-4000
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301059376207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4647680Medicaid
MIG84457Medicare UPIN
MI4647680Medicaid