Organization
FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ALAN WARGO M.D. (PHYSICIAN)
(815) 793-6611
Entity
Organization
Contact information
Practice address
1639 N 1590TH RD, STREATOR, IL 61364-9644
(815) 793-6611
(630) 592-7500
Mailing address
1639 N 1590TH RD, STREATOR, IL 61364-9644
(815) 793-6611
(630) 592-7500
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
036099987
IL
Other
Enumeration date
12/18/2012
Last updated
12/18/2012
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