Provider Demographics
NPI:1063075687
Name:GENDI, MARK WAGIH (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WAGIH
Last Name:GENDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0328
Mailing Address - Fax:
Practice Address - Street 1:17198 ST LUKES WAY STE 600
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8017
Practice Address - Country:US
Practice Address - Phone:936-266-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2025-07-14
Deactivation Date:2019-04-18
Deactivation Code:
Reactivation Date:2019-05-01
Provider Licenses
StateLicense IDTaxonomies
KY05886207X00000X
TXV9902207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27477312OtherTEXAS DEPARTMENT OF TRANSPORTATION