Provider Demographics
NPI:1548252364
Name:SURAN, MARK DAVID (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:SURAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 8TH AVE W
Mailing Address - Street 2:STE 101
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4008
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:12271 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8410
Practice Address - Country:US
Practice Address - Phone:941-776-4050
Practice Address - Fax:941-776-4057
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003659213ES0131X
IN07000627A213E00000X
FLPO1633213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60001608OtherBLUE CROSS PROVIDER ID
IN200899510Medicaid
IL016003659Medicaid
0732240001OtherDMERC # WITH PPG
IL60001608OtherBLUE CROSS PROVIDER ID
IL0854660001Medicare NSC
ILR00021Medicare PIN
IL016003659Medicaid
IL765650Medicare PIN
ILP00458161Medicare PIN
0732240001OtherDMERC # WITH PPG
INP00623832Medicare PIN
IN859800BBMedicare PIN
IL60001608OtherBLUE CROSS PROVIDER ID
ILP00458161Medicare PIN