# MARK AND KAMBOUR MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407012461
- **Authorized official:** MICHAEL GRATTENDICK (CFO)
- **Authorized official phone:** (561) 514-5822

## Contact information

- **Practice address:** 16250 NW 59TH AVE STE 201, MIAMI LAKES, FL 33014-7542
- **Practice address phone:** (866) 825-4422
- **Practice address fax:** (844) 751-9263
- **Mailing address:** 1355 RIVER BEND DR, DALLAS, TX 75247-4915

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | ME35456 | FL | Yes |

## Other

- **Enumeration date:** 07/30/2008
- **Last updated:** 09/05/2023