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NPI Code Detail

MEDICARE: DR. MARK DOMAAS DPM

MEDICARE: DR. MARK DOMAAS DPM
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
1213ES0103XFoot & Ankle Surgery Podiatrist016005716IL
2213E00000XPodiatrist82ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265845010
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK DOMAAS DPM
Provider Business Mailing Address
First Line : 1501 S CALIFORNIA AVE # 7-140
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1732
Country : US
Telephone Number : 773-542-2000
Fax Number :
Provider Business Practice Location Address
First Line : 1501 S CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1732
Country : US
Telephone Number : 773-542-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2014
Last Update Date : 03/18/2026

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