Healthcare Provider Details

I. General information

NPI: 1447350087
Provider Name (Legal Business Name): MARK TIMOTHY SENFT D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5591 PALANI RD SUITE #3006
KAILUA KONA HI
96740-3631
US

IV. Provider business mailing address

75-5591 PALANI RD SUITE #3006
KAILUA KONA HI
96740-3631
US

V. Phone/Fax

Practice location:
  • Phone: 808-331-8485
  • Fax: 808-331-1333
Mailing address:
  • Phone: 808-331-8485
  • Fax: 808-331-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO-140
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: