Individual
DR. MARK THOMAS NOOTENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
931 FRAN LIN PKWY, MUNSTER, IN 46321-3540
(219) 513-0107
(219) 513-0108
Mailing address
14125 HUSEMAN ST, CEDAR LAKE, IN 46303-9316
(219) 781-3191
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01042703
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000243924
ANTHEM PROVIDER #
IN
01
—
060070754
RR MEDICARE PROVIDER #
IN
05
—
200043060B
—
IN
05
—
303467487
—
IL
Enumeration date
06/30/2006
Last updated
09/08/2022
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