Provider Demographics
NPI:1972568491
Name:MARKELIS, MARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:MARKELIS
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 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4834
Mailing Address - Country:US
Mailing Address - Phone:954-456-5533
Mailing Address - Fax:954-456-6072
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4834
Practice Address - Country:US
Practice Address - Phone:954-456-5533
Practice Address - Fax:954-456-6072
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30744174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2499664OtherCIGNA
FL0004520509OtherAETNA PPO
FL0470249OtherUNITED HEALTHCARE HMO
FL0402719OtherUNITED HEALTHCARE OPEN ACCESS
FL1036392OtherAETNA HMO POS
FL2026MERLOtherNEIGHBORHOOD HEALTH
FL93406OtherBLUE CROSS BLUE SHIELD
FL2227668OtherAETNA HMO POS GRP
FL036731100Medicaid
FL1036392OtherAETNA HMO POS
FL0470249OtherUNITED HEALTHCARE HMO
FL036731100Medicaid