Provider Demographics
NPI:1851380349
Name:BISCHOF, MARC (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:BISCHOF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 522468
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32752-2468
Mailing Address - Country:US
Mailing Address - Phone:407-389-5300
Mailing Address - Fax:407-389-5363
Practice Address - Street 1:1134 KELTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3175
Practice Address - Country:US
Practice Address - Phone:407-381-7369
Practice Address - Fax:407-306-6375
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49233207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065638100Medicaid
FL02658YMedicare PIN
D50597Medicare UPIN
02658WMedicare PIN