MEDICARE: DR. DAVID ANTHONY MARKIEWICZ DMD

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	1223G0001X	General Practice Dentistry	019032108	IL

General Provider Information

NPI Number	:	1861046187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ANTHONY MARKIEWICZ DMD

Provider Business Mailing Address
First Line	:	1111 N MILWAUKEE AVE UNIT 236
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1658
Country	:	US
Telephone Number	:	847-312-8773
Fax Number	:

Provider Business Practice Location Address
First Line	:	852 NORTH RT 83
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-6006
Country	:	US
Telephone Number	:	847-566-2811
Fax Number	:

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

Provider Enumeration Date	:	07/25/2019
Last Update Date	:	07/25/2019

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