Basic Information
| Provider Information | |||||||||
| NPI: | 1285636639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUKAJ | ||||||||
| FirstName: | MARK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45640 SCHOENHERR RD | ||||||||
| Address2: | STE 150 | ||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483156033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865663092 | ||||||||
| FaxNumber: | 5865663093 | ||||||||
| Practice Location | |||||||||
| Address1: | 22201 MOROSS RD | ||||||||
| Address2: | STE 150 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482362169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138868787 | ||||||||
| FaxNumber: | 3138864103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 06/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD055760 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.