Provider Demographics
NPI:1538184569
Name:DOYSCHER, MARK WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:DOYSCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1791
Mailing Address - Country:US
Mailing Address - Phone:952-777-5553
Mailing Address - Fax:952-442-8055
Practice Address - Street 1:500 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1791
Practice Address - Country:US
Practice Address - Phone:952-777-5553
Practice Address - Fax:952-442-8055
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN286932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN120863OtherUCARE
MN1538184569OtherMEDICA
WI34615600Medicaid
MN960371010258OtherPREFERRED ONE
MN1538184569OtherAMERICA'S PPO
MNHP42307OtherHEALTHPARTNERS
MN592777300Medicaid
MN03M80DOOtherBLUE CROSS BLUE SHIELD
WI00635188OtherRR MEDICARE
MN592777300Medicaid
WI066556135Medicare PIN
WI007404070Medicare PIN
MN03M80DOOtherBLUE CROSS BLUE SHIELD
MN1538184569OtherAMERICA'S PPO
MNHP42307OtherHEALTHPARTNERS
MND48510Medicare UPIN