Provider Demographics
NPI:1497851687
Name:KAYLIN, MARK WARREN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WARREN
Last Name:KAYLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 NW 70TH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2385
Mailing Address - Country:US
Mailing Address - Phone:954-581-0200
Mailing Address - Fax:954-581-0203
Practice Address - Street 1:333 NW 70TH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2385
Practice Address - Country:US
Practice Address - Phone:954-581-0200
Practice Address - Fax:954-581-0203
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0065457207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B45565Medicare UPIN