Provider Demographics
NPI:1376581413
Name:SINIBALDI, MARK ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERT
Last Name:SINIBALDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12255 S 80TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1270
Mailing Address - Country:US
Mailing Address - Phone:708-923-7878
Mailing Address - Fax:708-923-7888
Practice Address - Street 1:12255 S 80TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1270
Practice Address - Country:US
Practice Address - Phone:708-923-7878
Practice Address - Fax:708-923-7888
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360501582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
219043OtherMAGELLAN
7229POtherCATERPILLAR
055429OtherVALUE BEHAVIORAL HEALTH
0991516762OtherBCBS
363827229 01OtherHERITAGE
L029112OtherCHAMPUS
260033354OtherRR MEDICARE
IL036050158Medicaid
363827229 01OtherJOHN DEERE
41832OtherJOHN HANCOCK
ILC38297Medicare UPIN
ILL58633Medicare ID - Type Unspecified
ILL21291Medicare ID - Type UnspecifiedDUPAGE COUNTY