Provider Demographics
NPI:1386823060
Name:MARIO MARKELIS & STEVEN J. RAPP MDS PA
Entity Type:Organization
Organization Name:MARIO MARKELIS & STEVEN J. RAPP MDS PA
Other - Org Name:DBA CENTER FOR INTERNAL MEDICINE & CARDIAC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-456-5533
Mailing Address - Street 1:2500 E. HALLANDALE BEACH BLVD
Mailing Address - Street 2:STE #QR
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:954-456-5533
Mailing Address - Fax:954-456-6072
Practice Address - Street 1:2500 E. HALLANDALE BEACH BLVD
Practice Address - Street 2:STE #QR
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-456-5533
Practice Address - Fax:954-456-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0007331008OtherAETNA
FL036033300OtherMEDICAID
FL0402718OtherUNITED HEALTHCARE
FL93406OtherBLUE CROSS BLUE SHIELD FL
FL0402719OtherUNITED HEALTHCARE
FL2227668OtherAETNA
FL93406UOtherPROVIDER'S PIN
FL0004520509OtherAETNA
FL0470249OtherUNITED HEALTHCARE
FL1408414OtherCIGNA
FL206931OtherAVMED
FL310768OtherAVMED
FL1036392OtherAETNA
FL2031MERLOtherNEIGHBORHOOD
FL036731100OtherMEDICAID
FL2296549OtherAETNA
FL7291886OtherCIGNA
FL94267WOtherPROVIDER'S PIN
FL0470248OtherUNITED HEALTHCARE
FL063856OtherNEIGHBORHOOD
FL2026MERLOtherNEIGHBORHOOD
FL2499664OtherCIGNA
FL94267OtherBLUE CROSS BLUE SHIELD FL
FL15728OtherAETNA
FL2499664OtherCIGNA