Healthcare Provider Details

I. General information

NPI: 1932449451
Provider Name (Legal Business Name): GACEK EAR AND SINUS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 HILLCREST RD STE A
MOBILE AL
36695-3904
US

IV. Provider business mailing address

4721 MORRISON DR STE 400
MOBILE AL
36609-3350
US

V. Phone/Fax

Practice location:
  • Phone: 251-340-7970
  • Fax: 251-340-7971
Mailing address:
  • Phone: 251-340-6947
  • Fax: 251-460-5457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0002170
License Number StateAL

VIII. Authorized Official

Name: DR. MARK R GACEK
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 251-340-7970