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General NPI Number Information
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NPI Number | 1831115674
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Entity Type | Individual
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Provider Name | MARK STEVEN WILLNER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 14201 W SUNRISE BLVD SUITE 208
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City | SUNRISE
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State | FL
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Zip | 33323-3207
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Country | US
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Telephone | 954-851-9690
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Fax | 954-851-9688
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Provider Business Mailing Address
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Address Line | 3820 WINDMILL LAKES RD
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City | WESTON
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State | FL
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Zip | 33332-2107
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Country | US
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Telephone | 954-851-9690
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Fax | 954-851-9688
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME52952
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License Number State | FL
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