Provider Demographics
NPI:1235196858
Name:BERK, MARK ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLAN
Last Name:BERK
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 1:900 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1674
Mailing Address - Country:US
Mailing Address - Phone:847-234-6121
Mailing Address - Fax:847-482-0363
Practice Address - Street 1:900 N WESTMORELAND RD
Practice Address - Street 2:SUITE 222
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1674
Practice Address - Country:US
Practice Address - Phone:847-234-6121
Practice Address - Fax:847-482-0363
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068947207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068947Medicaid
IL209949Medicare ID - Type UnspecifiedPROVIDER MEDICARE ID NUMB
IL036068947Medicaid