Provider Demographics
NPI:1760428890
Name:BERMAN, MARK (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2402 E HARBOR RIDGE WAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-4911
Mailing Address - Country:US
Mailing Address - Phone:847-245-4100
Mailing Address - Fax:847-245-4420
Practice Address - Street 1:10024 SKOKIE BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-9944
Practice Address - Country:US
Practice Address - Phone:847-674-1660
Practice Address - Fax:847-674-2688
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2012-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL16003176213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist