Travis, Mark S

Travis, Mark S is an individual health care provider with primary practice located at 1229 N North Branch St Suite 210, Chicago IL 60622-2473. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Nephrology, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Geriatric Medicine is his primary health care specialty. Travis, Mark S can be contacted via phone (312) 939-5090.

Contact Information

Primary practice address
1229 N North Branch St Suite 210 Chicago IL 60622-2473
Phone: (312) 939-5090
Fax: (312) 640-4496
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 01061315A Indiana
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 01061315A Indiana
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X Illinois

Profile Details

NPI number 1083690093
LBN Legal business name Travis, Mark S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 21st, 2005
Last updated Aug 1st, 2007 - about 17 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 1083690093 NPPES
Indiana Other 01061315A LICENSE NUMBER
Indiana Other 000000383791 LICENSE NUMBER

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