Provider Demographics
NPI:1922060292
Name:FISHMAN, MARK STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:FISHMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 SW 148TH AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4181
Mailing Address - Country:US
Mailing Address - Phone:954-438-7000
Mailing Address - Fax:954-589-1742
Practice Address - Street 1:3000 SW 148TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4181
Practice Address - Country:US
Practice Address - Phone:954-438-7000
Practice Address - Fax:954-589-1742
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9439208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00418194OtherMEDICARE RAILROAD RETIREMENT
FL002876700OtherGROUP MEDICAID
FL002422800Medicaid
K0493OtherGROUP MEDICARE PTAN
3983290001Medicare NSC
P00418194OtherMEDICARE RAILROAD RETIREMENT
K0493OtherGROUP MEDICARE PTAN