Individual
MARK ANTHONY IBARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 204-5108
Mailing address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 204-5108
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/11/2021
Last updated
05/11/2021
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