Carlson, Mark Edwin
Carlson, Mark Edwin is an individual health care provider with primary practice located at 1848 Daimler Rd , Rockford IL 61112-1019. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Carlson, Mark Edwin can be contacted via phone (815) 398-9100.Contact Information
Primary practice address
1848 Daimler Rd
Rockford IL 61112-1019
Phone: (815) 398-9100
Fax: (815) 986-6770
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 036-073115 | Illinois |
Profile Details
| NPI number | 1790741049 |
|---|---|
| LBN Legal business name | Carlson, Mark Edwin |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 25th, 2006 |
| Last updated | Sep 7th, 2010 - about 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790741049 | NPPES |
| Illinois | Other | K52428 | MEDICARE PTAN |
| Illinois | MEDICAID | 36073065 | MEDICARE PTAN |
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