Healthcare Provider Details

I. General information

NPI: 1770409401
Provider Name (Legal Business Name): JOHN MARK UFIR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 BIRCH TRL
WHEELING IL
60090-4413
US

IV. Provider business mailing address

53 BIRCH TRL
WHEELING IL
60090-4413
US

V. Phone/Fax

Practice location:
  • Phone: 847-217-8432
  • Fax:
Mailing address:
  • Phone: 847-217-8432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: