Healthcare Provider Details

I. General information

NPI: 1134745482
Provider Name (Legal Business Name): MARK MICHAEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 PALM HARBOR BLVD STE B
PALM HARBOR FL
34683-1416
US

IV. Provider business mailing address

3519 PALM HARBOR BLVD STE B
PALM HARBOR FL
34683-1416
US

V. Phone/Fax

Practice location:
  • Phone: 813-336-4461
  • Fax: 813-336-4466
Mailing address:
  • Phone: 813-336-4461
  • Fax: 813-336-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number1134745482
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberOS23442
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: