Healthcare Provider Details

I. General information

NPI: 1265774574
Provider Name (Legal Business Name): NATHAN MICHAEL MARKWART D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CLINT MOORE RD SUITE 100
BOCA RATON FL
33487-2768
US

IV. Provider business mailing address

9420 POINCIANA PL APT 403
DAVIE FL
33324-4848
US

V. Phone/Fax

Practice location:
  • Phone: 561-939-0200
  • Fax:
Mailing address:
  • Phone: 716-560-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS 13310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: