Provider Demographics
NPI:1437134905
Name:FISHBEIN, MARK H (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:FISHBEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:225 E CHICAGO AVE # 65
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-4597
Mailing Address - Fax:217-545-1884
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-4597
Practice Address - Fax:312-227-9645
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2020-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-0754092080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075409Medicaid
F04874Medicare UPIN