Healthcare Provider Details

I. General information

NPI: 1851380349
Provider Name (Legal Business Name): MARC BISCHOF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 KELTON AVE SUITE B
OCOEE FL
34761-3175
US

IV. Provider business mailing address

PO BOX 522468
LONGWOOD FL
32752-2468
US

V. Phone/Fax

Practice location:
  • Phone: 407-381-7369
  • Fax: 407-306-6375
Mailing address:
  • Phone: 407-389-5300
  • Fax: 407-389-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME49233
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: