Provider Demographics
NPI:1871557629
Name:WIDICK, MARK H (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:WIDICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:900 NW 13TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2350
Mailing Address - Country:US
Mailing Address - Phone:561-338-3267
Mailing Address - Fax:561-391-4420
Practice Address - Street 1:5130 LINTON BLVD STE E2
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6595
Practice Address - Country:US
Practice Address - Phone:561-391-3333
Practice Address - Fax:561-391-5618
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME65602207Y00000X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253536000Medicaid
FLF64642Medicare UPIN
FL25119WMedicare PIN