Provider Demographics
NPI:1235328238
Name:MARK HARVEY MDSC
Entity Type:Organization
Organization Name:MARK HARVEY MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-374-0933
Mailing Address - Street 1:7336 S OGLESBY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3412
Mailing Address - Country:US
Mailing Address - Phone:773-721-8557
Mailing Address - Fax:773-721-0135
Practice Address - Street 1:7336 S OGLESBY AVE
Practice Address - Street 2:7906 S CRANDON SUITE #2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3412
Practice Address - Country:US
Practice Address - Phone:773-721-8557
Practice Address - Fax:773-721-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210728Medicare PIN
ILE30898Medicare UPIN