Provider Demographics
NPI:1700896750
Name:VEXELMAN, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:VEXELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:150 E HURON STREET
Mailing Address - Street 2:SUITE 805
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2912
Mailing Address - Country:US
Mailing Address - Phone:312-649-6565
Mailing Address - Fax:312-649-9842
Practice Address - Street 1:150 E HURON STREET
Practice Address - Street 2:SUITE 805
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2912
Practice Address - Country:US
Practice Address - Phone:312-649-6565
Practice Address - Fax:312-649-9842
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036095873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095873Medicaid
ILK06441Medicare PIN
IL036095873Medicaid