Individual
DR. MARK DE SILVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17800 KEDZIE AVE, HAZEL CREST, IL 60429-2029
(708) 213-4200
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036077940
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01623845
BLUE CROSS & BLUE SHIELD
IL
05
—
036077940
—
IL
Enumeration date
11/08/2006
Last updated
09/16/2022
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