Provider Demographics
NPI:1124037890
Name:GERBER, MARK K (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:K
Last Name:GERBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2418
Mailing Address - Country:US
Mailing Address - Phone:773-278-0334
Mailing Address - Fax:773-365-0315
Practice Address - Street 1:3518 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2418
Practice Address - Country:US
Practice Address - Phone:773-278-0334
Practice Address - Fax:773-365-0315
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD1241Medicare UPIN
IL201887Medicare ID - Type Unspecified