Provider Demographics
NPI:1649347808
Name:DR MARK TRELKA LTD
Entity type:Organization
Organization Name:DR MARK TRELKA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRELKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-549-0232
Mailing Address - Street 1:565 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1857
Mailing Address - Country:US
Mailing Address - Phone:847-549-0232
Mailing Address - Fax:847-549-9329
Practice Address - Street 1:565 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1857
Practice Address - Country:US
Practice Address - Phone:847-549-0232
Practice Address - Fax:847-549-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360823942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082394Medicaid
IL03905078OtherBCBS
F27059Medicare UPIN
IL036082394Medicaid