Provider Demographics
NPI:1669509550
Name:FRITZ, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:FRITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:212 N LARKIN AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6604
Mailing Address - Country:US
Mailing Address - Phone:815-741-0666
Mailing Address - Fax:815-741-0649
Practice Address - Street 1:212 N LARKIN AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6604
Practice Address - Country:US
Practice Address - Phone:815-741-0666
Practice Address - Fax:815-741-0649
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2008-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036099618207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099618Medicaid
IL4502860001Medicare NSC
IL036099618Medicaid