Licht, Mark R
Licht, Mark R is an individual health care provider with primary practice located at 825 Century Medical Dr , Titusville FL 32796-2113. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Urology. Allopathic & Osteopathic Physicians / Urology is his primary health care specialty. Licht, Mark R can be contacted via phone (321) 268-6868.Contact Information
Primary practice address
825 Century Medical Dr
Titusville FL 32796-2113
Phone: (321) 268-6868
Fax: (321) 267-2713
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | ME68004 | Florida |
| Allopathic & Osteopathic Physicians / Urology | 208800000X | ME68004 | Florida |
Profile Details
| NPI number | 1306841473 |
|---|---|
| LBN Legal business name | Licht, Mark R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 16th, 2005 |
| Last updated | Apr 20th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306841473 | NPPES |
| Florida | MEDICAID | 101986000 |
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