Provider Demographics
NPI:1861505372
Name:MARK STURGE DPM PA
Entity Type:Organization
Organization Name:MARK STURGE DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:STURGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-251-5945
Mailing Address - Street 1:9299 SW 152ND ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1737
Mailing Address - Country:US
Mailing Address - Phone:305-251-5945
Mailing Address - Fax:954-671-1222
Practice Address - Street 1:9299 SW 152 ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1775
Practice Address - Country:US
Practice Address - Phone:305-251-5945
Practice Address - Fax:954-671-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2543213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390317600Medicaid
FL65434Medicare ID - Type Unspecified
FLU61916Medicare UPIN