Michael Park, MD | |
430 W Centre Ave, Portage, MI 49024-5304 | |
(269) 321-6673 | |
(269) 324-5594 |
Full Name | Michael Park |
---|---|
Gender | Male |
Speciality | Allergy & Immunology |
Location | 430 W Centre Ave, Portage, Michigan |
Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1942204680 | NPI | - | NPPES |
4111376 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207K00000X | Allergy & Immunology | 4301063179 (Michigan) | Primary |
Mailing Address | Practice Location Address |
---|---|
Michael Park, MD 430 W Centre Ave, Portage, MI 49024-5304 Ph: (269) 321-6673 | Michael Park, MD 430 W Centre Ave, Portage, MI 49024-5304 Ph: (269) 321-6673 |
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