Individual
MARK E MASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1025 W EVERETT RD, SUITE 101, LAKE FOREST, IL 60045-2697
(847) 234-7950
(847) 234-7940
Mailing address
475 MCCORMICK DR, LAKE FOREST, IL 60045-3349
(847) 814-9376
(847) 234-7940
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-093222
IL
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
36093222
IL
2083X0100X
Occupational Medicine Physician
036-093222
IL
261QU0200X
Urgent Care Clinic/Center
Primary
036-093222
IL
261QX0100X
Occupational Medicine Clinic/Center
036-093222
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36093222
—
IL
Enumeration date
12/21/2005
Last updated
04/23/2014
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