Provider Demographics
NPI:1013226703
Name:MARK S. REITER, M.D., S.C.
Entity Type:Organization
Organization Name:MARK S. REITER, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-499-2323
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:708-499-2323
Mailing Address - Fax:708-499-2324
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:SUITE 405
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-499-2323
Practice Address - Fax:708-499-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC44251Medicare UPIN