Ambrose, Mark

Ambrose, Mark is an individual health care provider with primary practice located at 3330 W 177Th St Suite 3E, Hazel Crest IL 60429-2184. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Ambrose, Mark can be contacted via phone (708) 206-0010.

Contact Information

Primary practice address
3330 W 177Th St Suite 3E Hazel Crest IL 60429-2184
Phone: (708) 206-0010
Fax: (708) 206-0020
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085000830 Illinois

Profile Details

NPI number 1043424740
LBN Legal business name Ambrose, Mark
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date May 10th, 2007
Last updated May 13th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1043424740 NPPES
Illinois Other K18310SC PROVIDER NO.

Popular Providers