Individual
MARK D GENDLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 RIDGE AVE, SUITE 103, EVANSTON, IL 60201-2455
(847) 475-4556
(847) 475-4565
Mailing address
2500 RIDGE AVE, SUITE 103, EVANSTON, IL 60201-2455
(847) 475-4556
(847) 475-4565
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036045834
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036045834
—
IL
Enumeration date
01/05/2006
Last updated
03/11/2015
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