Basic Information
| Provider Information | |||||||||
| NPI: | 1235455668 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR MARK E PAPPADOPOLI M D P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 236 E IRVING PARK RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | WOOD DALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601912099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308605160 | ||||||||
| FaxNumber: | 6308605262 | ||||||||
| Practice Location | |||||||||
| Address1: | 236 E IRVING PARK RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | WOOD DALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601912099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308605160 | ||||||||
| FaxNumber: | 6308605262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2010 | ||||||||
| LastUpdateDate: | 09/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | PAPPADOPOLI | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6308605160 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.