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:
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Health care specialties

SpecialtyCodeLicense #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 12 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 1700877339 NPPES
Indiana Other 000000735776 BCBS
Indiana MEDICAID 200233400 BCBS

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