Provider Demographics
NPI:1275068975
Name:DEMKE, DONALD MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MARK
Last Name:DEMKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11579 ACOSTA AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-8880
Mailing Address - Country:US
Mailing Address - Phone:407-217-5127
Mailing Address - Fax:
Practice Address - Street 1:11579 ACOSTA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-8880
Practice Address - Country:US
Practice Address - Phone:407-217-5127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine