Provider Demographics
NPI:1336366202
Name:MARK R WINKLER MD PA PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARK R WINKLER MD PA PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-882-5375
Mailing Address - Street 1:14366 SHAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3569
Mailing Address - Country:US
Mailing Address - Phone:818-882-5375
Mailing Address - Fax:
Practice Address - Street 1:14366 SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3569
Practice Address - Country:US
Practice Address - Phone:818-882-5375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G77560Medicaid
CAW18628Medicare ID - Type UnspecifiedMEDICARE