Healthcare Provider Details

I. General information

NPI: 1912992470
Provider Name (Legal Business Name): MARK CAMILLERI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 STANLEY AVE
BERWYN IL
60402-3041
US

IV. Provider business mailing address

6845 STANLEY AVE
BERWYN IL
60402-3041
US

V. Phone/Fax

Practice location:
  • Phone: 708-788-5232
  • Fax: 708-788-3618
Mailing address:
  • Phone: 708-788-5232
  • Fax: 708-788-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004695
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: