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General NPI Number Information
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NPI Number | 1295032258
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Entity Type | Individual
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Provider Name | MARK JAMES LLOYD LONDON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2011
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Last Update Date | 02/26/2011
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE MC 5031, DEPT OF SURGERY
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City | CHICAGO
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State | IL
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Zip | 60637-1447
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Country | US
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Telephone | 773-702-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3582
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City | PALMER
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State | AK
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Zip | 99645-3582
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Country | US
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Telephone | 207-807-1433
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036.126462
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License Number State | IL
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