Provider Demographics
NPI:1578552246
Name:FORRESTAL, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:FORRESTAL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1410 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:STE 300
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4827
Mailing Address - Country:US
Mailing Address - Phone:847-618-1740
Mailing Address - Fax:847-618-1749
Practice Address - Street 1:1410 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:STE 300
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4827
Practice Address - Country:US
Practice Address - Phone:847-618-1740
Practice Address - Fax:847-618-1749
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2020-03-03
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Provider Licenses
StateLicense IDTaxonomies
IL036-062967207R00000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601993OtherBCBS OF ILLINOIS
IL31601993OtherBCBS OF ILLINOIS
IL632000Medicare ID - Type Unspecified