Organization
MARK KONWISER MD PA
Active
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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