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NPI Code Detail

MEDICARE: MY N MARK M.D.

MEDICARE: MY N MARK M.D.
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
1207Q00000XFamily Medicine Physician036111701IL

General Provider Information

NPI Number : 1396772661
Entity Type Code : Individual
Provider Name (Legal Business Name) : MY N MARK M.D.
Provider Business Mailing Address
First Line : 928 N HOWE ST STE 1
Second Line :
City : CHICAGO
State : IL
Zip : 60610-7686
Country : US
Telephone Number : 847-867-8030
Fax Number :
Provider Business Practice Location Address
First Line : 4600 N RAVENSWOOD AVE FL 2
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4510
Country : US
Telephone Number : 773-561-7500
Fax Number : 773-561-7612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 04/09/2025

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Directions to “ MY N MARK M.D.” Practice Location

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