Provider Demographics
NPI:1043250566
Name:GENESEN, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:GENESEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-837-8601
Mailing Address - Fax:760-837-8611
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-837-8610
Practice Address - Fax:760-837-8611
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-10-25
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Provider Licenses
StateLicense IDTaxonomies
CAG061853207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE98073Medicare UPIN
OKOK404990Medicare PIN