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1407852353

NPI Code Detail

MEDICARE: MARK D MARILLEY MD

MEDICARE: MARK D MARILLEY 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	207RG0100X	Gastroenterology Physician	DR.0067585	CO
2	207RG0100X	Gastroenterology Physician	MD192722	OR
3	207RG0100X	Gastroenterology Physician	200700105	NC
4	207RG0100X	Gastroenterology Physician	MD425171	PA
5	207RG0100X	Gastroenterology Physician	21764	WV
6	207RG0100X	Gastroenterology Physician	21216	ND
7	207RG0100X	Gastroenterology Physician	350085209	GA
8	207RG0100X	Gastroenterology Physician	ME157995	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SZ970	OTHER	FL	MEDICARE HF

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	144T9	OTHER	NC	BCBSNC
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407852353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK D MARILLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 SE HOSPITAL AVE
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2346
Country	:	US
Telephone Number	:	772-287-5200
Fax Number	:

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	06/17/2025

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Directions to “ MARK D MARILLEY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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