Individual
DR. MARK MACUMBER
Active
Individual
DR. MARK MACUMBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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