Healthcare Provider Details

I. General information

NPI: 1215627088
Provider Name (Legal Business Name): MGHMI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6109 N DAVIS HWY
PENSACOLA FL
32504-6949
US

IV. Provider business mailing address

6109 N DAVIS HWY
PENSACOLA FL
32504-6949
US

V. Phone/Fax

Practice location:
  • Phone: 850-741-2251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MARK S ISENBERG
Title or Position: OWNER
Credential: DPM
Phone: 727-639-1973