Provider Demographics
NPI:1124563986
Name:MARK CHARRETTE ENTERPRISES LLC
Entity Type:Organization
Organization Name:MARK CHARRETTE ENTERPRISES LLC
Other - Org Name:INTEGRATED HEALTH & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARRETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-285-1012
Mailing Address - Street 1:500 FLOWER MOUND RD SPC 104
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3418
Mailing Address - Country:US
Mailing Address - Phone:214-285-1012
Mailing Address - Fax:214-285-1014
Practice Address - Street 1:500 FLOWER MOUND RD SPC 104
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3418
Practice Address - Country:US
Practice Address - Phone:214-285-1012
Practice Address - Fax:214-285-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty