Basic Information
| Provider Information | |||||||||
| NPI: | 1396952271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SENITKO | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 HIGHWAY 90 | ||||||||
| Address2: | |||||||||
| City: | GAUTIER | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395535340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2284977576 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3635 BIENVILLE BLVD | ||||||||
| Address2: | |||||||||
| City: | OCEAN SPRINGS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395645711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288721951 | ||||||||
| FaxNumber: | 2288759998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21218 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 17578 | NV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 2020011730 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RN0300X | M4522 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RC0200X | 21218 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 187822501 | 05 | TX | MEDICAID |