Organization
MARK D GENDLEMAN MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK GENDLEMAN M.D. (PRESIDENT)
(847) 475-4556
Entity
Organization
Contact information
Practice address
2500 RIDGE AVE STE 103, EVANSTON, IL 60201-2468
(847) 475-4556
(847) 475-4565
Mailing address
2500 RIDGE AVE STE 103, EVANSTON, IL 60201-2468
(847) 475-4556
(847) 475-4565
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
036045834
IL
Other
Enumeration date
12/02/2010
Last updated
12/02/2010
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