Provider Demographics
NPI:1831115674
Name:WILLNER, MARK STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:WILLNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3820 WINDMILL LAKES RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-2107
Mailing Address - Country:US
Mailing Address - Phone:954-851-9690
Mailing Address - Fax:954-851-9688
Practice Address - Street 1:14201 W SUNRISE BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3207
Practice Address - Country:US
Practice Address - Phone:954-851-9690
Practice Address - Fax:954-851-9688
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME529522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry