Provider Demographics
NPI:1871543678
Name:PASCHALL, MARK R (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:PASCHALL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:24911 LITTLE MACK AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3200
Mailing Address - Country:US
Mailing Address - Phone:586-447-9060
Mailing Address - Fax:586-447-9081
Practice Address - Street 1:24911 LITTLE MACK AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3200
Practice Address - Country:US
Practice Address - Phone:586-447-9060
Practice Address - Fax:586-447-9081
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-01-06
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Provider Licenses
StateLicense IDTaxonomies
MI4301049934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H208910OtherBCBS GROUP
MI4080672Medicaid
MI4080672Medicaid
MI0H208910OtherBCBS GROUP
MIB46800Medicare UPIN