Healthcare Provider Details

I. General information

NPI: 1720071228
Provider Name (Legal Business Name): MARK I BLOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date: 03/23/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

1150 N 35TH AVE STE 660
HOLLYWOOD FL
33021-5471
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-1125
  • Fax: 954-985-5578
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME91707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: