Mark James Bielaczyc, M.D.
Individual provider Active NPI Anesthesiology Physician · Petoskey, MI
NPI 1043311640 · NPPES record last updated Sep 21, 2012
Key facts
- NPI
- 1043311640
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 4301403857 (MI)
- Practice address
- 416 Connable Ave
Petoskey, MI 49770-2212 - Phone
- (231) 348-2795
- Fax
- (231) 348-2031
- NPI assigned
- Sep 26, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301403857 | MI | MD | Anesthesiology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 4301403857 | MI | Yes |
Addresses
Primary practice location
416 Connable Ave
Petoskey, MI 49770-2212
Mailing address
602 Jackson St
Petoskey, MI 49770-2220
Phone (231) 348-2795
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1830812 | Medicaid | MI |
Other providers in Petoskey, MI
- Ryan Ber
- Kathy Ann Berchem
- Shannon Marie Bice
- Shannon R Bieber
- Andrew Bielaczyc
- Sue Bissell I
- Thomas Richard Biziorek
- Paul D Blanchard
- Keely Marie Blosh
- Amy Bodnarchuk
All providers in Petoskey, MI · Anesthesiology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.