MEDICARE: MARK VANANROOY PA

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	363AM0700X	Medical Physician Assistant	085001774	IL

General Provider Information

NPI Number	:	1578541470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK VANANROOY PA

Provider Business Mailing Address
First Line	:	1235 NORTH MULFORD ROAD
Second Line	:	SUITE 222
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3879
Country	:	US
Telephone Number	:	815-397-8400
Fax Number	:	815-229-0050

Provider Business Practice Location Address
First Line	:	1235 NORTH MULFORD ROAD
Second Line	:	SUITE 222
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3879
Country	:	US
Telephone Number	:	815-397-8400
Fax Number	:	815-229-0050

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	12/11/2024

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Directions to “ MARK VANANROOY PA” Practice Location

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