Gendleman, Mark D

Gendleman, Mark D is an individual health care provider with primary practice located at 2500 Ridge Ave Suite 103, Evanston IL 60201-2455. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Gendleman, Mark D can be contacted via phone (847) 475-4556.

Contact Information

Primary practice address
2500 Ridge Ave Suite 103 Evanston IL 60201-2455
Phone: (847) 475-4556
Fax: (847) 475-4565
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 036045834 Illinois

Profile Details

NPI number 1457339863
LBN Legal business name Gendleman, Mark D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 5th, 2006
Last updated Mar 11th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457339863 NPPES
Illinois MEDICAID 036045834

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