Individual
MARK L. LUNDINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1253 N ALPINE RD, ROCKFORD, IL 61107-2201
(779) 696-9201
Mailing address
PO BOX 1567, ROCKFORD, IL 61110-0067
(779) 696-7150
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036-059144
IL
207YS0123X
Facial Plastic Surgery Physician
036059144
IL
Other
Enumeration date
09/04/2006
Last updated
10/19/2017
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