Provider Demographics
NPI:1154328177
Name:ISENBERG, MARK S (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:ISENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6109 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6949
Mailing Address - Country:US
Mailing Address - Phone:850-741-2251
Mailing Address - Fax:866-258-9993
Practice Address - Street 1:6109 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6949
Practice Address - Country:US
Practice Address - Phone:850-741-2251
Practice Address - Fax:866-258-9993
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00001247213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55570Medicare UPIN
FL87845GMedicare ID - Type Unspecified