Provider Demographics
NPI:1184811317
Name:MARK AKSELRUD MD PA
Entity type:Organization
Organization Name:MARK AKSELRUD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:AKSELRUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-721-9898
Mailing Address - Street 1:7421 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2977
Mailing Address - Country:US
Mailing Address - Phone:954-721-9898
Mailing Address - Fax:954-721-9810
Practice Address - Street 1:7421 N UNIVERSITY DR
Practice Address - Street 2:SUITE 309
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2977
Practice Address - Country:US
Practice Address - Phone:954-721-9898
Practice Address - Fax:954-721-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH705Medicare PIN