Provider Demographics
NPI:1740579481
Name:VEIN CARE SPECIALISTS OF SOUTH FLORIDA, INC
Entity Type:Organization
Organization Name:VEIN CARE SPECIALISTS OF SOUTH FLORIDA, INC
Other - Org Name:DR MARK J MARZANO MD
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-430-8346
Mailing Address - Street 1:2338 IMMOKALEE RD
Mailing Address - Street 2:STE 116
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1445
Mailing Address - Country:US
Mailing Address - Phone:239-384-9480
Mailing Address - Fax:239-384-9681
Practice Address - Street 1:1350 TAMIAMI TRL N
Practice Address - Street 2:STE 204
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5209
Practice Address - Country:US
Practice Address - Phone:239-430-8346
Practice Address - Fax:239-384-9681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81325174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51707OtherBLUE CROSS BLUE SHIELD PROVIDER
FL260090100Medicaid
FL51707OtherBLUE CROSS BLUE SHIELD PROVIDER
FLC42814Medicare UPIN
FLE4746UMedicare PIN