Individual
MARK SONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2650 RIDGE AVE, BURCH 221, EVANSTON, IL 60201
(847) 570-1440
(847) 570-1442
Mailing address
2650 RIDGE AVE, BURCH 221, EVANSTON, IL 60201-1718
(847) 570-1440
(847) 570-1442
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085007006
IL
Other
Enumeration date
03/19/2019
Last updated
09/07/2021
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