Individual
DR. MARK MACUMBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3277 E LOUISE DR STE 360, MERIDIAN, ID 83642-9359
(208) 600-1550
(208) 600-1551
Mailing address
3114 W IRVING PARK RD STE 1W, CHICAGO, IL 60618-3435
(312) 600-4526
(714) 363-3847
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
036-096467
IL
207Q00000X
Family Medicine Physician
036096467
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036096467
—
IL
01
—
789510
GROUP MEDICARE PTAN
IL
01
—
789511
GROUP MEDICARE PTAN
IL
Enumeration date
02/07/2007
Last updated
05/14/2024
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