Healthcare Provider Details

I. General information

NPI: 1447427869
Provider Name (Legal Business Name): MARK HAUPT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ DEPARTMENT OF PULMONARY MEDICINE, BOX 43
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

2300 N CHILDRENS PLZ DEPARTMENT OF PULMONARY MEDICINE, BOX 43
CHICAGO IL
60614-3363
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-8105
  • Fax:
Mailing address:
  • Phone: 773-880-8105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number036.123458
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: