Provider Demographics
NPI:1649272766
Name:GINKEL, MARK L (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:GINKEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:220 S PALISADE DR
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8902
Mailing Address - Country:US
Mailing Address - Phone:805-354-0112
Mailing Address - Fax:805-354-0234
Practice Address - Street 1:220 S PALISADE DR
Practice Address - Street 2:SUITE # 101
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8902
Practice Address - Country:US
Practice Address - Phone:805-354-0112
Practice Address - Fax:805-354-0234
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-03-02
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Provider Licenses
StateLicense IDTaxonomies
CAG71322207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFM518ZMedicare PIN