Mcgillem, Mark Jay
Mcgillem, Mark Jay is an individual health care provider with primary practice located at 5215 Holy Cross Pkwy , Mishawaka IN 46545-1469. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Mcgillem, Mark Jay can be contacted via phone (574) 335-2521.Contact Information
Primary practice address
5215 Holy Cross Pkwy
Mishawaka IN 46545-1469
Phone: (574) 335-2521
Fax: (574) 335-2262
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 01051194A | Indiana |
Profile Details
NPI number | 1700877339 |
---|---|
LBN Legal business name | Mcgillem, Mark Jay |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Nov 2nd, 2005 |
Last updated | Mar 15th, 2012 - about 13 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1700877339 | NPPES |
Indiana | Other | 000000735776 | BCBS |
Indiana | MEDICAID | 200233400 | BCBS |
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