Provider Demographics
NPI:1720222193
Name:MORK, GREGORY KARL (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:KARL
Last Name:MORK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1324 N SHERIDAN RD
Mailing Address - Street 2:VISTA MEDICAL CENTER
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2161
Mailing Address - Country:US
Mailing Address - Phone:847-360-4189
Mailing Address - Fax:847-360-4013
Practice Address - Street 1:1324 N SHERIDAN RD
Practice Address - Street 2:VISTA MEDICAL CENTER
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2161
Practice Address - Country:US
Practice Address - Phone:847-360-4189
Practice Address - Fax:847-360-4013
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2010-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI52821-0212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology