Provider Demographics
NPI:1275658536
Name:MCALLISTER, MARK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:MCALLISTER
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 1:24040 S TAMIAMI TRL STE 202
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7040
Mailing Address - Country:US
Mailing Address - Phone:239-624-7100
Mailing Address - Fax:239-624-7101
Practice Address - Street 1:24040 S TAMIAMI TRL STE 202
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7040
Practice Address - Country:US
Practice Address - Phone:239-624-7100
Practice Address - Fax:239-624-7101
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051610207Q00000X
FLME57718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000754000Medicaid
FL7UJYGOtherBCBS
FL7UJYGOtherBCBS
MI284270010Medicaid
MIMI2817Medicare PIN
FL7UJYGOtherBCBS