Healthcare Provider Details

I. General information

NPI: 1295032258
Provider Name (Legal Business Name): MARK JAMES LLOYD LONDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2011
Last Update Date: 02/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE MC 5031, DEPT OF SURGERY
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

PO BOX 3582
PALMER AK
99645-3582
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax:
Mailing address:
  • Phone: 207-807-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.126462
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: