Provider Demographics
NPI:1992748198
Name:HABEKOVIC, MARKO (MD)
Entity type:Individual
Prefix:
First Name:MARKO
Middle Name:
Last Name:HABEKOVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E PARIS AVE SE STE 111
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3680
Mailing Address - Country:US
Mailing Address - Phone:616-222-4111
Mailing Address - Fax:616-222-4119
Practice Address - Street 1:1000 E PARIS AVE SE STE 111
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3680
Practice Address - Country:US
Practice Address - Phone:616-222-4111
Practice Address - Fax:616-222-4119
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076276207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M74460254Medicare PIN
MIOD16150108Medicare ID - Type Unspecified
I11700Medicare UPIN