Healthcare Provider Details

I. General information

NPI: 1063075687
Provider Name (Legal Business Name): MARK WAGIH GENDI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date: 04/18/2019
Reactivation Date: 05/01/2019

III. Provider practice location address

17198 ST LUKES WAY STE 600
THE WOODLANDS TX
77384-8017
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 936-266-2650
  • Fax:
Mailing address:
  • Phone: 502-588-0328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number05886
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberV9902
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberV9902
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: