# MARK D GENDLEMAN MD SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730481375
- **Authorized official:** DR. MARK GENDLEMAN M.D. (PRESIDENT)
- **Authorized official phone:** (847) 475-4556

## Contact information

- **Practice address:** 2500 RIDGE AVE STE 103, EVANSTON, IL 60201-2468
- **Practice address phone:** (847) 475-4556
- **Practice address fax:** (847) 475-4565
- **Mailing address:** 2500 RIDGE AVE STE 103, EVANSTON, IL 60201-2468
- **Mailing address phone:** (847) 475-4556
- **Mailing address fax:** (847) 475-4565

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 036045834 | IL | Yes |

## Other

- **Enumeration date:** 12/02/2010
- **Last updated:** 12/02/2010