Provider Demographics
NPI:1942201694
Name:SEIFERT, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:SEIFERT
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 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:623-434-6200
Mailing Address - Fax:623-434-6164
Practice Address - Street 1:9250 N 3RD STREET
Practice Address - Street 2:SUITE 3010
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2425
Practice Address - Country:US
Practice Address - Phone:602-861-1168
Practice Address - Fax:602-861-1763
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33429207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCSKQOtherSUN HEALTH GROUP #
AZP00162117OtherRAILROAD MEDICARE
AZ363599Medicaid
AZZ140390Medicare PIN
AZWCSKQOtherSUN HEALTH GROUP #