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NPI Code Detail

MEDICARE: MARK MENCH M.D.

MEDICARE: MARK MENCH 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
1207P00000XEmergency Medicine Physician036061486IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1010033947OTHERILRAILROAD MEDICARE

General Provider Information

NPI Number : 1750333589
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK MENCH M.D.
Provider Business Mailing Address
First Line : 100 E LE FEVRE RD
Second Line :
City : STERLING
State : IL
Zip : 61081-1278
Country : US
Telephone Number : 815-625-0400
Fax Number : 815-625-2747
Provider Business Practice Location Address
First Line : 100 E LE FEVRE RD
Second Line :
City : STERLING
State : IL
Zip : 61081-1278
Country : US
Telephone Number : 815-625-0400
Fax Number : 815-625-2747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 04/20/2012

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