MEDICARE: MARK D FORRESTAL MD

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	207R00000X	Internal Medicine Physician	036-062967	IL
2	202K00000X	Phlebology Physician	036-062967	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31601993	OTHER	IL	BCBS OF ILLINOIS

General Provider Information

NPI Number	:	1578552246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK D FORRESTAL MD

Provider Business Mailing Address
First Line	:	1410 N ARLINGTON HEIGHTS RD
Second Line	:	STE 300
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4827
Country	:	US
Telephone Number	:	847-618-1740
Fax Number	:	847-618-1749

Provider Business Practice Location Address
First Line	:	1410 N ARLINGTON HEIGHTS RD
Second Line	:	STE 300
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4827
Country	:	US
Telephone Number	:	847-618-1740
Fax Number	:	847-618-1749

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	03/03/2020

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Directions to “ MARK D FORRESTAL MD” Practice Location

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