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NPI Code Detail

MEDICARE: ROBERT M MANDELKORN, M.D., INC.

MEDICARE: ROBERT M MANDELKORN, M.D., INC.
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
1207W00000XOphthalmology PhysicianME80929FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME80929OTHERFLFLORIDA MEDICAL LICENSE
21457455990OTHERINDIVIDUAL NPI

General Provider Information

NPI Number : 1871807420
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT M MANDELKORN, M.D., INC.
Provider Business Mailing Address
First Line : 1510 ROYAL PALM SQUARE BLVD
Second Line : STE 106
City : FORT MYERS
State : FL
Zip : 33919-1068
Country : US
Telephone Number : 239-939-3937
Fax Number : 239-275-8045
Provider Business Practice Location Address
First Line : 1510 ROYAL PALM SQUARE BLVD
Second Line : STE 106
City : FORT MYERS
State : FL
Zip : 33919-1068
Country : US
Telephone Number : 239-939-3937
Fax Number : 239-275-8045
Authorized Official
Title or Position : PRESIDENT
Name : DR. ROBERT MARC MANDELKORN
Credential : M.D.
Telephone Number : 239-939-3937
Provider Enumeration Date : 08/05/2010
Last Update Date : 08/05/2010

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