Provider Demographics
NPI:1720005291
Name:TRELKA, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:TRELKA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:565 LAKEVIEW PKWY
Mailing Address - Street 2:STE 104
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1857
Mailing Address - Country:US
Mailing Address - Phone:847-549-0232
Mailing Address - Fax:847-549-9329
Practice Address - Street 1:565 LAKEVIEW PKWY
Practice Address - Street 2:STE 104
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1857
Practice Address - Country:US
Practice Address - Phone:847-549-0232
Practice Address - Fax:847-549-9329
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360823942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03905078OtherBLUE CROSS BLUE SHIELD
IL036082394Medicaid
IL03905078OtherBLUE CROSS BLUE SHIELD