=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447351044
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK J KATZENSTEIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 129 E. REDSTONE AVE SUITE A
-----------------------------------------------------
City | CRESTVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-682-7212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 129 E. REDSTONE AVE SUITE A
-----------------------------------------------------
City | CRESTVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-682-7212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | ME0060331
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------