Healthcare Provider Details

I. General information

NPI: 1104040252
Provider Name (Legal Business Name): MARK DAVID BUZZELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NW 10TH AVE STE T-215
MIAMI FL
33136-1018
US

IV. Provider business mailing address

1800 NW 10TH AVE STE T-215
MIAMI FL
33136-1018
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1403
  • Fax:
Mailing address:
  • Phone: 305-585-1178
  • Fax: 305-326-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME132324
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME132324
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME132324
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: