Individual
MR. THOMAS MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
370 SUMMIT ST, ELGIN, IL 60120-3843
(847) 608-1344
Mailing address
172 LAKESIDE DR, APT. 1916, ST CHARLES, IL 60174-7940
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003372
IL
Other
Enumeration date
01/06/2009
Last updated
01/06/2009
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