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General NPI Number Information
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NPI Number | 1871557629
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Entity Type | Individual
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Provider Name | MARK H WIDICK MD
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Gender | Male
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 5130 LINTON BLVD STE E2
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City | DELRAY BEACH
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State | FL
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Zip | 33484-6595
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Country | US
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Telephone | 561-391-3333
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Fax | 561-391-5618
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Provider Business Mailing Address
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Address Line | 900 NW 13TH ST SUITE 206
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City | BOCA RATON
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State | FL
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Zip | 33486-2350
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Country | US
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Telephone | 561-338-3267
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Fax | 561-391-4420
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME65602
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number | ME65602
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License Number State | FL
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