Provider Demographics
NPI:1447351044
Name:KATZENSTEIN, MARK J (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:KATZENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 E. REDSTONE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539
Mailing Address - Country:US
Mailing Address - Phone:850-682-7212
Mailing Address - Fax:
Practice Address - Street 1:129 E. REDSTONE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539
Practice Address - Country:US
Practice Address - Phone:850-682-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060331207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD49569Medicare UPIN
FL14219ZMedicare ID - Type Unspecified