Provider Demographics
NPI:1659374551
Name:PATLOVICH, MARK F (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:PATLOVICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6716 NW 11TH PLACE
Mailing Address - Street 2:STE 200
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4215
Mailing Address - Country:US
Mailing Address - Phone:352-331-9729
Mailing Address - Fax:352-331-0136
Practice Address - Street 1:6716 NW 11TH PLACE
Practice Address - Street 2:STE 200
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4215
Practice Address - Country:US
Practice Address - Phone:352-331-9729
Practice Address - Fax:352-371-3372
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME419752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270855OtherAVMED
FLP00451900OtherRAILROAD MEDICARE
FL067736100Medicaid
FL239216OtherAVMED
FLP00084967OtherRAILROAD MEDICARE
FLP00084967OtherRAILROAD MEDICARE
FL239216OtherAVMED
FLP00084967OtherRAILROAD MEDICARE