MEDICARE: MARK T UPTON MD FACC SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0031604062	OTHER	IL	BLUE CROSS / BLUE SHIELD

General Provider Information

NPI Number	:	1184699563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK T UPTON MD FACC SC

Provider Business Mailing Address
First Line	:	1730 PARK ST
Second Line	:	SUITE 101
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-2688
Country	:	US
Telephone Number	:	630-718-0200
Fax Number	:	630-718-0900

Provider Business Practice Location Address
First Line	:	233 E ERIE ST
Second Line	:	SUITE 412
City	:	CHICAGO
State	:	IL
Zip	:	60611-2926
Country	:	US
Telephone Number	:	312-573-0973
Fax Number	:	312-573-0973

Authorized Official
Title or Position	:	PHYSICIAN / OWNER
Name	:	DR. MARK T UPTON
Credential	:	M.D.
Telephone Number	:	630-718-0200

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	02/26/2015

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