Organization
MARK TOMERA MC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH BRUNDGAE (DIRECTOR OF OPERATIONS)
(708) 366-7177
Entity
Organization
Contact information
Practice address
7579 LAKE ST, RIVER FOREST, IL 60305-1846
(708) 366-7177
Mailing address
7579 LAKE ST, RIVER FOREST, IL 60305-1846
(708) 366-7177
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036065652
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036065652
—
IL
Enumeration date
06/19/2008
Last updated
06/19/2008
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