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NPI Code Detail

MEDICARE: MARK G BANDYK MD

MEDICARE: MARK G BANDYK 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
1208800000XUrology PhysicianME89653FL

Other Identifiers

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

General Provider Information

NPI Number : 1790778009
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK G BANDYK MD
Provider Business Mailing Address
First Line : 1324 LAKELAND HILLS BLVD
Second Line : ATTN: MEDICAL STAFF OFFICE
City : LAKELAND
State : FL
Zip : 33805-4543
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3525 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-1965
Country : US
Telephone Number : 863-603-6565
Fax Number : 863-904-1961
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2005
Last Update Date : 07/29/2015

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