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General NPI Number Information
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NPI Number | 1508923376
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Entity Type | Individual
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Provider Name | MARK JOSEPH MAGENHEIM MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1760 MOUND ST
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City | SARASOTA
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State | FL
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Zip | 34236-7761
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Country | US
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Telephone | 941-954-1600
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Fax | 941-951-2629
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Provider Business Mailing Address
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Address Line | 4571 ROBIN HOOD TRL W
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City | SARASOTA
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State | FL
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Zip | 34232-2640
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Country | US
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Telephone | 941-954-1600
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Fax | 941-951-2629
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 44765
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License Number State | FL
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