Fountain Healthcare Limited Liability Company

NPI 1730425851 - Family Medicine - 207QA0505X

NPI Details
NPI 1730425851
Enumeration Date 12/18/2012
Last Updated 12/18/2012
Entity Type Healthcare Provider
Active Over 3 years ago
Authorized Information
Name MARK ALAN MARK
Position PHYSICIAN
Phone (815) 793-6611
Fax (630) 592-7500
Practice Location
1639 N 1590TH RD
STREATOR IL, 61364-9644, US
Phone (815) 793-6611
Fax (630) 592-7500
Business Location
1639 N 1590TH RD
STREATOR IL, 61364-9644, US
Phone (815) 793-6611
Fax (630) 592-7500
Toxanomy
Taxonomy Code 207QA0505X
License State Illinois
License Number 036099987
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According to our database, Fountain Healthcare Limited Liability Company NPI is 1730425851, taxonomy code is 207QA0505X and license number is 036099987, license state is located at Illinois. Fountain Healthcare Limited Liability Company physically located at 1639 N 1590th Rd, Streator IL, 61364-9644. NPI Number 1033115704 has the healthcare provider type.

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1730425851 NPI number is provided on an as is basis without warranty of any kind. 1730425851 is maintained by the National Plan & Provider Enumeration System. The contents of Fountain Healthcare Limited Liability Company are for informational purposes only.