Provider Demographics
NPI:1639613920
Name:MARK D FORRESTAL MD SC
Entity Type:Organization
Organization Name:MARK D FORRESTAL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORRESTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-618-1740
Mailing Address - Street 1:PO BOX 1215
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-1215
Mailing Address - Country:US
Mailing Address - Phone:844-276-4181
Mailing Address - Fax:
Practice Address - Street 1:1410 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4822
Practice Address - Country:US
Practice Address - Phone:847-618-1740
Practice Address - Fax:847-618-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF30032196Medicare PIN