Provider Demographics
NPI:1336752799
Name:ASSMUS, MARK ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALEXANDER
Last Name:ASSMUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10370 HALIGUS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9582
Mailing Address - Country:US
Mailing Address - Phone:847-802-7090
Mailing Address - Fax:847-802-7095
Practice Address - Street 1:10370 HALIGUS RD STE 201
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9582
Practice Address - Country:US
Practice Address - Phone:847-802-7090
Practice Address - Fax:847-802-7095
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01084087A208800000X
IL036154910208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology