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Individual

MARK ATKINSON VANGORDER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
20201 CRAWFORD AVE, OLYMPIA FIELDS, IL 60461-1010
(708) 747-4000
(708) 503-3242
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(800) 288-8325
(419) 866-5453

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
01053877A
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036104407
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000648429
BC/BS
IN
01
01630255
BC/BC
IL
01
070058
CCN
IN
01
199791
BC/BS
IN
05
200327850
IN
01
220032191
RR MEDICARE
IN
01
351173213
HFN
IN
01
9512355002
CIGNA
IN
01
P00818143
RAILROAD MEDICARE
IN
Enumeration date
08/25/2005
Last updated
01/23/2024
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