Provider Demographics
NPI:1972599199
Name:MARKS, MITCHELL L (DO)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:L
Last Name:MARKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3345 BURNS RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4304
Mailing Address - Country:US
Mailing Address - Phone:561-622-2022
Mailing Address - Fax:561-622-6775
Practice Address - Street 1:3345 BURNS RD
Practice Address - Street 2:STE 101
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4304
Practice Address - Country:US
Practice Address - Phone:561-622-2022
Practice Address - Fax:561-622-6775
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS5567207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80109ZMedicare PIN
FLD18414Medicare UPIN