Organization
MARK KONWISER MD PA
Active
Other names
Mark Konwiser MD PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK KONWISER M.D. (OWNER/PHYSICIAN)
(941) 474-8811
Entity
Organization
Contact information
Practice address
900 PINE ST, BLDG 1 STE 122, ENGLEWOOD, FL 34223-4418
(941) 474-8811
(941) 473-0058
Mailing address
900 PINE ST, BLDG 1 STE 122, ENGLEWOOD, FL 34223-4418
(941) 474-8811
(941) 473-0058
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME00050766
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D0295356
CLIA #
FL
01
—
22-0003555
RAIL ROAD MEDICARE #
FL
01
—
85944
OCCUPATIONAL LICENSE
FL
01
—
ME00050766
LIC NUMBER FLORIDA
FL
Enumeration date
08/23/2006
Last updated
06/21/2018
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