Provider Demographics
NPI:1043247976
Name:YOUNG, MARK D (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:D
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:405 S MISSION
Mailing Address - Street 2:STE 2
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-772-3588
Mailing Address - Fax:989-772-0469
Practice Address - Street 1:405 S MISSION
Practice Address - Street 2:STE 2
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-772-3588
Practice Address - Fax:989-772-3588
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMY001144213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4853750000OtherBCBS
MI5375000Medicare ID - Type Unspecified
MI0455050001Medicare NSC
T33983Medicare UPIN