Basic Information
Provider Information
NPI: 1699413765
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIGBY
FirstName: MARK
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11105 BALDWIN CIR
Address2:  
City: HOLLY
State: MI
PostalCode: 484429380
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1 GENESYS PKWY
Address2:  
City: GRAND BLANC
State: MI
PostalCode: 484398065
CountryCode: US
TelephoneNumber: 8106065000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/26/2022
LastUpdateDate: 05/26/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/26/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X5151015776MIY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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