Provider Demographics
NPI:1447289285
Name:HATCH, MARK E (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:HATCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S CREYTS RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8290
Mailing Address - Country:US
Mailing Address - Phone:517-886-0333
Mailing Address - Fax:517-886-2072
Practice Address - Street 1:416 S CREYTS RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8290
Practice Address - Country:US
Practice Address - Phone:517-886-0333
Practice Address - Fax:517-886-2072
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMH008596207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1592069Medicaid
MIE26367Medicare UPIN
MI1592069Medicaid