Provider Demographics
NPI:1609849561
Name:WERNER, MARK (MD, PC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:WERNER
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28300 ORCHARD LAKE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3704
Mailing Address - Country:US
Mailing Address - Phone:248-855-5640
Mailing Address - Fax:248-855-7440
Practice Address - Street 1:28300 ORCHARD LAKE RD STE 201
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3704
Practice Address - Country:US
Practice Address - Phone:248-855-5640
Practice Address - Fax:248-855-7440
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043585207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E26436Medicare UPIN
0632892Medicare ID - Type Unspecified