Provider Demographics
NPI:1780640862
Name:SANDHOUSE, MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SANDHOUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3200 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 4316
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2018
Mailing Address - Country:US
Mailing Address - Phone:954-262-4316
Mailing Address - Fax:954-262-3538
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:SUITE 4316
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-4316
Practice Address - Fax:954-262-3538
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS0005718207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80235Medicare ID - Type Unspecified
FLF06923Medicare UPIN