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Individual

ROBERT MARK MAYERSON

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
2601 BUNKER HILL DR, ALGONQUIN, IL 60102-9780
(847) 658-2500
Mailing address
280 W TREEHOUSE LN, ROUND LAKE, IL 60073-3597
(847) 546-4368

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
96001932
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
96001932
STATE OF IL ATC LICENSE
IL
Enumeration date
02/14/2006
Last updated
07/08/2007
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