MEDICARE: MARK R WINKLER MD PA PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G67756	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336366202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK R WINKLER MD PA PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	14366 SHAWNEE ST
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-3569
Country	:	US
Telephone Number	:	818-882-5375
Fax Number	:

Provider Business Practice Location Address
First Line	:	14366 SHAWNEE ST
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-3569
Country	:	US
Telephone Number	:	818-882-5375
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK WINKLER
Credential	:
Telephone Number	:	818-882-5375

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	03/29/2018

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