Individual
MR. MARK WILDEBOER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, OCS
Contact information
Practice address
1401 S. CALIFORNIA BLVD, CHICAGO, IL 60608
(773) 522-2010
Mailing address
1401 S. CALIFORNIA BLVD, CHICAGO, IL 60608
(773) 522-2010
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
070015786
IL
Other
Enumeration date
09/05/2012
Last updated
09/05/2012
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