Provider Demographics
NPI:1689690406
Name:TALAMONTI, MARK (MD)
Entity Type:Individual
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First Name:MARK
Middle Name:
Last Name:TALAMONTI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:EVANSTON HOSPITAL
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2800
Practice Address - Fax:847-570-2930
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-02-10
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Provider Licenses
StateLicense IDTaxonomies
IL0360712562086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E52122Medicare UPIN