Provider Demographics
NPI:1013068311
Name:PRAIRIE GLEN FAMILY MEDICINE
Entity Type:Organization
Organization Name:PRAIRIE GLEN FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DREXLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-904-7800
Mailing Address - Street 1:2550 COMPASS RD
Mailing Address - Street 2:SUITE A-B
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1610
Mailing Address - Country:US
Mailing Address - Phone:847-904-7800
Mailing Address - Fax:847-904-7122
Practice Address - Street 1:2550 COMPASS RD
Practice Address - Street 2:SUITE A-B
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1610
Practice Address - Country:US
Practice Address - Phone:847-904-7800
Practice Address - Fax:847-904-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty