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General NPI Number Information
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NPI Number | 1659648350
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Entity Type | Organization
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Legal Business Name | MARK L. MIDENBERG
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 115 QUEENSBURY DR SW
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City | HUNTSVILLE
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State | AL
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Zip | 35802-1501
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Country | US
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Telephone | 256-880-0222
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Fax | 256-880-3404
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Provider Business Mailing Address
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Address Line | 115 QUEENSBURY DR SW
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City | HUNTSVILLE
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State | AL
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Zip | 35802-1501
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Country | US
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Telephone | 256-880-0222
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Fax | 256-880-3404
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Authorized Official
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Title or Position | OWNER
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Name | MARK L MIDENBERG
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Credential | D.P.M.
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Telephone | 256-880-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | AL116
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License Number State | AL
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