Healthcare Provider Details

I. General information

NPI: 1295779239
Provider Name (Legal Business Name): MARK K ISONIEMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/08/2023
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E WILLOW AVE
WHEATON IL
60187-5476
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-510-6900
  • Fax: 630-871-6706
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036101563
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: