MEDICARE: MARK TOMERA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	036065652	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	31603127	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1043311665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK TOMERA MD

Provider Business Mailing Address
First Line	:	PO BOX 616
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-0616
Country	:	US
Telephone Number	:	708-366-7177
Fax Number	:	708-366-3301

Provider Business Practice Location Address
First Line	:	7579 LAKE ST
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1846
Country	:	US
Telephone Number	:	708-366-7177
Fax Number	:	708-366-3301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/01/2008

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Directions to “ MARK TOMERA MD” Practice Location

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