Healthcare Provider Details

I. General information

NPI: 1457794406
Provider Name (Legal Business Name): DANIEL MARKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MADISON ST STE 207
JOLIET IL
60435-6654
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-0018
US

V. Phone/Fax

Practice location:
  • Phone: 815-740-1900
  • Fax: 815-729-3294
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036-149816
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: