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NPI Code Detail

MEDICARE: DR. MARK DAVID SURAN D.P.M.

MEDICARE: DR. MARK DAVID SURAN D.P.M.
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
1213ES0131XFoot Surgery Podiatrist016-003659IL
2213E00000XPodiatrist07000627AIN
3213ES0131XFoot Surgery PodiatristPO1633FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
160001608OTHERILBLUE CROSS PROVIDER ID
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
40732240001OTHERDMERC # WITH PPG

General Provider Information

NPI Number : 1548252364
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK DAVID SURAN D.P.M.
Provider Business Mailing Address
First Line : 700 8TH AVE W
Second Line : STE 101
City : PALMETTO
State : FL
Zip : 34221-4737
Country : US
Telephone Number : 941-776-4008
Fax Number : 941-845-4963
Provider Business Practice Location Address
First Line : 12271 US HIGHWAY 301 N
Second Line :
City : PARRISH
State : FL
Zip : 34219-8410
Country : US
Telephone Number : 941-776-4050
Fax Number : 941-776-4057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 03/27/2017

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