Provider Demographics
NPI:1982690830
Name:CHOI, MARK (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 OAK PARK AVE
Mailing Address - Street 2:METROPOLITAN ADVANCED RADIOLOGICAL SERVICES, LTD
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3429
Mailing Address - Country:US
Mailing Address - Phone:708-783-2696
Mailing Address - Fax:708-783-3164
Practice Address - Street 1:3249 OAK PARK AVE
Practice Address - Street 2:METROPOLITAN ADVANCED RADIOLOGICAL SERVICES, LTD
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3429
Practice Address - Country:US
Practice Address - Phone:708-783-2696
Practice Address - Fax:708-783-3164
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN020029622085R0202X
WI46602-0212085R0202X
NVDO13912085R0202X
OH34.0092652085R0202X
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00455855OtherMEDICARE RAILROAD
IN405600 SMedicare ID - Type Unspecified
ILK39022Medicare PIN
ILP00455855OtherMEDICARE RAILROAD