Healthcare Provider Details

I. General information

NPI: 1487145629
Provider Name (Legal Business Name): MARK HOVLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 22ND AVE
MONROE WI
53566-1569
US

IV. Provider business mailing address

621 S ILLINOIS AVE STE 103
MASON CITY IA
50401-5489
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-2000
  • Fax:
Mailing address:
  • Phone: 641-428-3041
  • Fax: 641-428-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-11198
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number75516
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: