Hanson, Mark J

Hanson, Mark J is an individual health care provider with primary practice located at 1111 Trinity Lane Suite 111, Bloomington IL 61704-3738. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Sports Medicine, Allopathic & Osteopathic Physicians / Orthopaedic Surgery. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Hanson, Mark J can be contacted via phone (309) 663-6461.

Contact Information

Primary practice address
1111 Trinity Lane Suite 111 Bloomington IL 61704-3738
Phone: (309) 663-6461
Fax: (309) 663-5711
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 036106045 Illinois
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 036106045 Illinois

Profile Details

NPI number 1548276256
LBN Legal business name Hanson, Mark J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 1st, 2006
Last updated Oct 27th, 2021 - about 4 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 1548276256 NPPES
Illinois MEDICAID 036106045

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