MEDICARE: MARK CHOI DO

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	2085R0202X	Diagnostic Radiology Physician	02002962	IN
2	2085R0202X	Diagnostic Radiology Physician	46602-021	WI
3	2085R0202X	Diagnostic Radiology Physician	DO1391	NV
4	2085R0202X	Diagnostic Radiology Physician	34.009265	OH
5	2085R0202X	Diagnostic Radiology Physician		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00455855	OTHER	IL	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1982690830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK CHOI DO

Provider Business Mailing Address
First Line	:	3249 OAK PARK AVE
Second Line	:	METROPOLITAN ADVANCED RADIOLOGICAL SERVICES, LTD
City	:	BERWYN
State	:	IL
Zip	:	60402-3429
Country	:	US
Telephone Number	:	708-783-2696
Fax Number	:	708-783-3164

Provider Business Practice Location Address
First Line	:	3249 OAK PARK AVE
Second Line	:	METROPOLITAN ADVANCED RADIOLOGICAL SERVICES, LTD
City	:	BERWYN
State	:	IL
Zip	:	60402-3429
Country	:	US
Telephone Number	:	708-783-2696
Fax Number	:	708-783-3164

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	04/16/2008

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Directions to “ MARK CHOI DO” Practice Location

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