Healthcare Provider Details

I. General information

NPI: 1538255229
Provider Name (Legal Business Name): MARK R BIELEFELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 3RD ST STE 1
CORPUS CHRISTI TX
78404-2354
US

IV. Provider business mailing address

PO BOX 30104
CORPUS CHRISTI TX
78463-0104
US

V. Phone/Fax

Practice location:
  • Phone: 361-854-0201
  • Fax: 361-855-7572
Mailing address:
  • Phone: 361-854-0201
  • Fax: 361-855-7572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberL1528
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: