Individual
MARK I BLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1150 N 35TH AVE STE 660, HOLLYWOOD, FL 33021-5471
(954) 265-1125
(954) 985-5578
Mailing address
2900 CORPORATE WAY, DOOR D, MIRAMAR, FL 33025-3925
(954) 276-5685
(954) 985-7074
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME91707
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271273300
—
FL
Enumeration date
08/30/2005
Last updated
03/16/2021
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