MEDICARE: DR. MARK W TURNER PSY 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
1	103TC0700X	Clinical Psychologist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01627973	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1619947520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK W TURNER PSY D

Provider Business Mailing Address
First Line	:	139 STONEGATE RD
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1914
Country	:	US
Telephone Number	:	847-577-1155
Fax Number	:	847-577-3858

Provider Business Practice Location Address
First Line	:	139 STONEGATE RD
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1914
Country	:	US
Telephone Number	:	847-577-1155
Fax Number	:	847-577-3858

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/21/2022

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