Provider Demographics
NPI:1548591845
Name:MARK NOOTENS, MD, PC
Entity Type:Organization
Organization Name:MARK NOOTENS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOOTENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-513-0107
Mailing Address - Street 1:931 FRAN LIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3540
Mailing Address - Country:US
Mailing Address - Phone:219-513-0107
Mailing Address - Fax:219-513-0108
Practice Address - Street 1:931 FRAN LIN PKWY
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3540
Practice Address - Country:US
Practice Address - Phone:219-513-0107
Practice Address - Fax:219-513-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042703207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000243924OtherBCBS
1568491975OtherPHYCISIAN NPI
IN200043060BMedicaid
IL330467487OtherIL MEDICAID
1568491975OtherPHYCISIAN NPI
IN200043060BMedicaid