Healthcare Provider Details

I. General information

NPI: 1073491346
Provider Name (Legal Business Name): MARK ANTHONY ARTABA AGNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6841 N FRANCISCO AVE
CHICAGO IL
60645-2927
US

IV. Provider business mailing address

2930 N PINE GROVE AVE APT 101
CHICAGO IL
60657-5754
US

V. Phone/Fax

Practice location:
  • Phone: 929-491-7700
  • Fax:
Mailing address:
  • Phone: 616-416-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209033256
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number041541036
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: