MEDICARE: DR. MARK JAMES CORSALE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD12132	SC
2	2084P0800X	Psychiatry Physician	056532	GA
3	2084P0800X	Psychiatry Physician	ME58087	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356471999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK JAMES CORSALE MD

Provider Business Mailing Address
First Line	:	4740 N STATE ROAD 7 STE 201
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5839
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5800
Country	:	US
Telephone Number	:	954-486-4005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	06/11/2025

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