Provider Demographics
NPI:1508308750
Name:MARK SOBOR, MD
Entity Type:Organization
Organization Name:MARK SOBOR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMASZEWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-308-6103
Mailing Address - Street 1:3749 N KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3022
Mailing Address - Country:US
Mailing Address - Phone:773-725-1267
Mailing Address - Fax:773-725-1267
Practice Address - Street 1:13560 76TH ST
Practice Address - Street 2:UNIT 2
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-9483
Practice Address - Country:US
Practice Address - Phone:269-206-3260
Practice Address - Fax:269-216-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102383261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0800105OtherBCBSMI
MIMI9960Medicare PIN
MI0800105OtherBCBSMI