Grevious, Mark Allen

Grevious, Mark Allen is an individual health care provider with primary practice located at 7905 Calumet Ave , Munster IN 46321-2549. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Plastic Surgery, Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Plastic Surgery is his primary health care specialty. Grevious, Mark Allen can be contacted via phone (219) 836-7506.

Contact Information

Primary practice address
7905 Calumet Ave Munster IN 46321-2549
Phone: (219) 836-7506
Fax: (219) 836-7515
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X 01060561A Indiana
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X 036100551 Illinois
Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery 2086S0122X 036100551 Illinois
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X 72578 Minnesota
Allopathic & Osteopathic Physicians / Surgery 208600000X 036100551 Illinois
Allopathic & Osteopathic Physicians / Surgery 208600000X 01060561A Indiana

Profile Details

NPI number 1194727909
LBN Legal business name Grevious, Mark Allen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 11th, 2005
Last updated May 13th, 2024 - about last year

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 1194727909 NPPES
Illinois MEDICAID 036-100551-1

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