Individual
MARK NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
150 E WILLOW AVE STE 300, WHEATON, IL 60187-5529
(630) 510-6900
(630) 871-6706
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-0018
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036072356
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036072356
—
IL
Enumeration date
03/08/2006
Last updated
02/24/2021
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