MEDICARE: MARK A. JONES DPM, LLC

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	213E00000X	Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK4224	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1632199	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1558583898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK A. JONES DPM, LLC

Provider Business Mailing Address
First Line	:	25 E SCHAUMBURG RD STE 110
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60194-3548
Country	:	US
Telephone Number	:	847-352-1473
Fax Number	:	847-352-1479

Provider Business Practice Location Address
First Line	:	25 E SCHAUMBURG RD STE 110
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60194-3548
Country	:	US
Telephone Number	:	847-352-1473
Fax Number	:	847-352-1479

Authorized Official
Title or Position	:	OWNER
Name	:	MARK ALAN JONES
Credential	:	DPM
Telephone Number	:	847-352-1473

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	06/11/2019

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