Provider Demographics
NPI:1770501306
Name:STERN, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2151 WAUKEGAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1885
Mailing Address - Country:US
Mailing Address - Phone:847-444-5300
Mailing Address - Fax:847-267-0694
Practice Address - Street 1:767 PARK AVENUE WEST
Practice Address - Street 2:SUITE 340
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-444-5300
Practice Address - Fax:847-267-0694
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36044361207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB4267OtherRAILROAD MEDICARE
IL04915267OtherBLUE CROSS BLUE SHIELD
IL36044361Medicaid
IL36044361Medicaid
ILP11832Medicare PIN
IL04915267OtherBLUE CROSS BLUE SHIELD