De Silva, Mark

De Silva, Mark is an individual health care provider with primary practice located at 17800 Kedzie Ave , Hazel Crest IL 60429-2029. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. De Silva, Mark can be contacted via phone (708) 213-4200.

Contact Information

Primary practice address
17800 Kedzie Ave Hazel Crest IL 60429-2029
Phone: (708) 213-4200
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 036077940 Illinois

Profile Details

NPI number 1609945922
LBN Legal business name De Silva, Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 8th, 2006
Last updated Sep 16th, 2022 - about 3 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609945922 NPPES
Illinois Other 01623845 BLUE CROSS & BLUE SHIELD
Illinois MEDICAID 036077940 BLUE CROSS & BLUE SHIELD

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