Provider Demographics
NPI:1780863183
Name:MARK & KAMBOUR, LLC
Entity Type:Organization
Organization Name:MARK & KAMBOUR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-626-5512
Mailing Address - Street 1:11360 N JOG RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1749
Mailing Address - Country:US
Mailing Address - Phone:561-626-5512
Mailing Address - Fax:561-626-4530
Practice Address - Street 1:5000 UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146
Practice Address - Country:US
Practice Address - Phone:305-669-3471
Practice Address - Fax:305-668-2026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AURORA DIAGNOSTICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory