Healthcare Provider Details

I. General information

NPI: 1831473784
Provider Name (Legal Business Name): MARK E. DUBIN, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GRAND CANYON PKWY SUITE 108
HOFFMAN ESTATES IL
60169-1705
US

IV. Provider business mailing address

PO BOX 5075
BUFFALO GROVE IL
60089-5075
US

V. Phone/Fax

Practice location:
  • Phone: 847-490-9901
  • Fax: 847-490-0930
Mailing address:
  • Phone: 847-490-9901
  • Fax: 847-490-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036-078199
License Number StateIL

VIII. Authorized Official

Name: DR. MARK E DUBIN
Title or Position: OWNER
Credential: M.D.
Phone: 847-490-9901