Provider Demographics
NPI:1508923376
Name:MAGENHEIM, MARK JOSEPH (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:MAGENHEIM
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4571 ROBIN HOOD TRL W
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2640
Mailing Address - Country:US
Mailing Address - Phone:941-954-1600
Mailing Address - Fax:941-951-2629
Practice Address - Street 1:1760 MOUND ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7761
Practice Address - Country:US
Practice Address - Phone:941-954-1600
Practice Address - Fax:941-951-2629
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL447652083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2303150OtherLICENSE REGISTRATION
FL44765OtherMEDICAL LICENSE NUMBER
FLAM9289922OtherDEA REGISTRATION NUMBER
FLAM9289922OtherDEA REGISTRATION NUMBER
FL07266ZMedicare ID - Type Unspecified