Provider Demographics
NPI:1033102371
Name:MOLESKI, MARK OWEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:OWEN
Last Name:MOLESKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:791 KENMOOR SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8625
Mailing Address - Country:US
Mailing Address - Phone:616-575-8200
Mailing Address - Fax:616-954-9622
Practice Address - Street 1:791 KENMOOR SE
Practice Address - Street 2:SUITE A CASCADE OPHTHALMOLOGY PC
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8625
Practice Address - Country:US
Practice Address - Phone:616-575-8200
Practice Address - Fax:616-954-9622
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2015-03-16
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Provider Licenses
StateLicense IDTaxonomies
MI4301043504207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0358470002OtherDMERC
MI2116382Medicaid
MI180410703OtherBLUE CROSS
MI2116382Medicaid
MI180410703OtherBLUE CROSS