Individual
MARK WAVRUNEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4800 MAINE ST, QUINCY, IL 62305-5875
(217) 214-3823
Mailing address
4800 MAINE ST, QUINCY, IL 62305-5875
(217) 214-3823
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
41000333A
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016005840
IL
Other
Enumeration date
06/19/2015
Last updated
01/02/2024
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