Provider Demographics
NPI:1417067869
Name:CHEIKEN, MARK S (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:CHEIKEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:8 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3808
Mailing Address - Country:US
Mailing Address - Phone:386-446-4466
Mailing Address - Fax:386-446-6066
Practice Address - Street 1:8 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3808
Practice Address - Country:US
Practice Address - Phone:386-446-4466
Practice Address - Fax:386-446-6066
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7202207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS7202OtherSTATE LICENSE
FLOS7202OtherSTATE LICENSE
G29575Medicare UPIN