Healthcare Provider Details

I. General information

NPI: 1902880107
Provider Name (Legal Business Name): MARK ERNEST TOTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NAVARRE PL STE. 4400
SOUTH BEND IN
46601-1156
US

IV. Provider business mailing address

3355 DOUGLAS RD STE. 300
SOUTH BEND IN
46635-1781
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-4535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01024987A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: