MEDICARE: DR. MARK CHARLES CHOTTINER 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	207P00000X	Emergency Medicine Physician	125.068459	IL

General Provider Information

NPI Number	:	1821446006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK CHARLES CHOTTINER M.D.

Provider Business Mailing Address
First Line	:	110 S PACA ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-1642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE # MC5068
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-9500
Fax Number	:	773-702-3135

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

Provider Enumeration Date	:	05/29/2016
Last Update Date	:	04/28/2026

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