Healthcare Provider Details

I. General information

NPI: 1205832045
Provider Name (Legal Business Name): MARK P BEHAR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 03/07/2023
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 N MARTIN LUTHER KING DRIVE
MILWAUKEE WI
53212-2709
US

IV. Provider business mailing address

2555 N MARTIN LUTHER KING DRIVE
MILWAUKEE WI
53212-2709
US

V. Phone/Fax

Practice location:
  • Phone: 414-372-8080
  • Fax: 414-372-2309
Mailing address:
  • Phone: 414-267-3633
  • Fax: 414-372-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102835
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3020023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: