Provider Demographics
NPI:1831473784
Name:MARK E. DUBIN, M.D., LLC
Entity Type:Organization
Organization Name:MARK E. DUBIN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-490-9901
Mailing Address - Street 1:PO BOX 5075
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-5075
Mailing Address - Country:US
Mailing Address - Phone:847-490-9901
Mailing Address - Fax:847-490-0930
Practice Address - Street 1:1000 GRAND CANYON PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1705
Practice Address - Country:US
Practice Address - Phone:847-490-9901
Practice Address - Fax:847-490-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-078199207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty