# ROBERT M MANDELKORN, M.D., INC.

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

## Provider details

- **NPI number:** 1871807420
- **Authorized official:** DR. ROBERT MARC MANDELKORN M.D. (PRESIDENT)
- **Authorized official phone:** (239) 939-3937

## Contact information

- **Practice address:** 1510 ROYAL PALM SQUARE BLVD, STE 106, FORT MYERS, FL 33919-1068
- **Practice address phone:** (239) 939-3937
- **Practice address fax:** (239) 275-8045
- **Mailing address:** 1510 ROYAL PALM SQUARE BLVD, STE 106, FORT MYERS, FL 33919-1068
- **Mailing address phone:** (239) 939-3937
- **Mailing address fax:** (239) 275-8045

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | ME80929 | FL | Yes |

## Other

- **Enumeration date:** 08/05/2010
- **Last updated:** 08/05/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1457455990 | INDIVIDUAL NPI | — |
| 01 | — | ME80929 | FLORIDA MEDICAL LICENSE | FL |