Healthcare Provider Details

I. General information

NPI: 1255080685
Provider Name (Legal Business Name): KAR SHUN CONSTANT MAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DON WICKHAM DR
CLERMONT FL
34711-1979
US

IV. Provider business mailing address

1900 DON WICKHAM DR MP SLH
CLERMONT FL
34711-1979
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-4071
  • Fax: 352-536-8841
Mailing address:
  • Phone: 352-394-4071
  • Fax: 352-536-8841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME173559
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: