Provider Demographics
NPI:1184989220
Name:QUERY, MARK E (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:QUERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL LN STE 220
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1845
Mailing Address - Country:US
Mailing Address - Phone:317-745-3758
Mailing Address - Fax:317-745-3749
Practice Address - Street 1:100 HOSPITAL LN STE 220
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1845
Practice Address - Country:US
Practice Address - Phone:317-745-3758
Practice Address - Fax:317-745-3749
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMTL002742207Y00000X
IN01077630A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300050161Medicaid