Provider Demographics
NPI:1023121167
Name:GOODE, MARK L (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:GOODE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3231 EUCLID AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3471
Mailing Address - Country:US
Mailing Address - Phone:708-783-2644
Mailing Address - Fax:708-783-3973
Practice Address - Street 1:3231 EUCLID AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3471
Practice Address - Country:US
Practice Address - Phone:708-783-2644
Practice Address - Fax:708-783-0514
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036089656207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089656Medicaid
IL36089656OtherSTATE OF ILLINOIS LICENSE
IL110205012OtherRAILROAD MEDICARE PIN
ILH08113Medicare UPIN
IL110205012OtherRAILROAD MEDICARE PIN
IL036089656Medicaid