Dehaan, Mark R

Dehaan, Mark R is an individual health care provider with primary practice located at 1111 Leffingwell Ave Ne Suite 200, Grand Rapids MI 49525-6406. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Plastic Surgery, Allopathic & Osteopathic Physicians / Surgery of the Hand, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery of the Hand is his primary health care specialty. Dehaan, Mark R can be contacted via phone (616) 459-7101.

Contact Information

Primary practice address
1111 Leffingwell Ave Ne Suite 200 Grand Rapids MI 49525-6406
Phone: (616) 459-7101
Fax: (616) 464-6170
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X 4301044330 Michigan
Allopathic & Osteopathic Physicians / Surgery of the Hand 2082S0105X 4301044330 Michigan
Allopathic & Osteopathic Physicians / Surgery 208600000X 4301044330 Michigan
Allopathic & Osteopathic Physicians / Surgery of the Hand 2086S0105X 4301044330 Michigan

Profile Details

NPI number 1093707093
LBN Legal business name Dehaan, Mark R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 17th, 2005
Last updated Jul 1st, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093707093 NPPES
Michigan MEDICAID 4096420

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