Individual
DR. MARK EDWARD MIDDENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5522 TAYLOR MILL RD, TAYLOR MILL, KY 41015-2264
(857) 491-2855
(859) 655-4395
Mailing address
2300 CHAMBER CENTER DR, LAKESIDE PARK, KY 41017-1673
(859) 344-5555
(859) 655-4395
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20166
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0461441
—
OH
05
—
64201668
—
KY
Enumeration date
04/12/2006
Last updated
09/28/2015
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