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Organization
FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY
Active
Organization
FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ALAN WARGO M.D. (PHYSICIAN)
(815) 793-6611
Entity
Organization
Contact information
Practice address
1639 N 1590TH RD, STREATOR, IL 61364-9644
(815) 793-6611
(630) 592-7500
Mailing address
1639 N 1590TH RD, STREATOR, IL 61364-9644
(815) 793-6611
(630) 592-7500
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
036099987
IL
Other
Enumeration date
12/18/2012
Last updated
12/18/2012
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