Provider Demographics
NPI:1447350087
Name:SENFT, MARK TIMOTHY (DPM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:TIMOTHY
Last Name:SENFT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-5591 PALANI RD
Mailing Address - Street 2:SUITE #3006
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3631
Mailing Address - Country:US
Mailing Address - Phone:808-331-8485
Mailing Address - Fax:808-331-1333
Practice Address - Street 1:75-5591 PALANI RD
Practice Address - Street 2:SUITE #3006
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3631
Practice Address - Country:US
Practice Address - Phone:808-331-8485
Practice Address - Fax:808-331-1333
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO-140213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMEDICAIDOther49356001
HIHMSAOther22042-6
HIT15837Medicare UPIN
HI52443Medicare PIN