Provider Demographics
NPI:1558418848
Name:EHMKE, FREDERICK MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:MARK
Last Name:EHMKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:398 E ALTAMONTE DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4402
Mailing Address - Country:US
Mailing Address - Phone:407-331-9355
Mailing Address - Fax:407-331-9481
Practice Address - Street 1:398 E ALTAMONTE DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4402
Practice Address - Country:US
Practice Address - Phone:407-331-9355
Practice Address - Fax:407-331-9481
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME975172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D21081Medicare UPIN