Provider Demographics
NPI:1699861088
Name:KARCHON, MARK P (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:KARCHON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 674852
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-4852
Mailing Address - Country:US
Mailing Address - Phone:248-360-6000
Mailing Address - Fax:248-360-6040
Practice Address - Street 1:2455 UNION LAKE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-3554
Practice Address - Country:US
Practice Address - Phone:248-360-6000
Practice Address - Fax:248-360-6040
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMK008912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0156336445OtherBCBS
MI113028319Medicaid
P00095533OtherRAILROAD MEDICARE
MI0156336445OtherBCBS
MIP35120143Medicare PIN
E26382Medicare UPIN