MEDICARE: MARK TOMERA MC

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

General Provider Information

NPI Number	:	1386805570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK TOMERA MC

Provider Business Mailing 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	:

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	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	ELIZABETH BRUNDGAE
Credential	:
Telephone Number	:	708-366-7177

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	06/19/2008

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