Provider Demographics
NPI:1114993250
Name:UPTON, MARK T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:UPTON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1730 PARK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2688
Mailing Address - Country:US
Mailing Address - Phone:630-718-0200
Mailing Address - Fax:630-718-0900
Practice Address - Street 1:233 E ERIE ST
Practice Address - Street 2:SUITE 412
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2926
Practice Address - Country:US
Practice Address - Phone:312-573-0973
Practice Address - Fax:312-573-0973
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC41938Medicare UPIN