MEDICARE: MARK S GIRGUIS 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	2085R0202X	Diagnostic Radiology Physician	ME112607	FL
2	2085R0202X	Diagnostic Radiology Physician	036166384	IL
3	2085R0202X	Diagnostic Radiology Physician	D79826	MD
4	2085R0202X	Diagnostic Radiology Physician	A82528	CA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477591154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK S GIRGUIS MD

Provider Business Mailing Address
First Line	:	40946 US HIGHWAY 19 N # 101
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-5446
Country	:	US
Telephone Number	:	813-720-7237
Fax Number	:	888-366-6013

Provider Business Practice Location Address
First Line	:	40946 US HIGHWAY 19 N # 101
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-5446
Country	:	US
Telephone Number	:	813-720-7237
Fax Number	:	888-366-6013

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	11/22/2024

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Directions to “ MARK S GIRGUIS MD” Practice Location

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