NPI 1730481375

Mark D Gendleman MD Sc

Organisation Exclusive Provider Organization Evanston, IL

Practice location

Address: 2500 Ridge Ave STE 103, Evanston, IL 60201-2468
Phone: (847) 475-4556
Fax: (847) 475-4565

Authorised official

Name: Mark Gendleman
Title: President
Phone: (847) 475-4556

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 036045834 (IL)

Other Exclusive Provider Organization providers in Illinois →

Registry record

NPI: 1730481375
Entity type: Organization
NPI issued: 2 Dec 2010
Record last updated: 2 Dec 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.