Provider Demographics
NPI:1710180518
Name:EDWARDS, MARK R (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:EDWARDS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1203 HADLEY RD STE 204
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1885
Practice Address - Country:US
Practice Address - Phone:317-834-8062
Practice Address - Fax:317-834-8092
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2023-03-16
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Provider Licenses
StateLicense IDTaxonomies
IN01063774A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery