Provider Demographics
NPI:1528065323
Name:MIGHELL, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:MIGHELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13020 N TELECOM PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0925
Mailing Address - Country:US
Mailing Address - Phone:813-978-9700
Mailing Address - Fax:813-558-6135
Practice Address - Street 1:13020 N TELECOM PKWY
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0925
Practice Address - Country:US
Practice Address - Phone:813-978-9700
Practice Address - Fax:813-558-6135
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME77360207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1262132OtherCIGNA
FL200041125OtherMEDICARE RR
FL51706OtherBCBS OF FL
FL258906100Medicaid
FL276467OtherAVMED
FL7500217OtherAETNA
FLF52973Medicare UPIN
FL1262132OtherCIGNA