MEDICARE: DR. MARK BERNARD LUBIENSKI M.D.

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	208D00000X	General Practice Physician	036071444	IL
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	036071444	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1376543025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK BERNARD LUBIENSKI M.D.

Provider Business Mailing Address
First Line	:	372 RED BUD CT
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-2128
Country	:	US
Telephone Number	:	708-710-6048
Fax Number	:	815-464-1984

Provider Business Practice Location Address
First Line	:	372 RED BUD CT
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-2128
Country	:	US
Telephone Number	:	708-710-6048
Fax Number	:	815-464-1984

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	03/21/2013

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