Active NPI
Mark Loren Keldahl, MD
- Vascular Surgery Physician
- Chicago, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- 036-117220
- Practice address
- 3000 N. Halsted St.
Suite 703
Chicago, IL 60657 - Phone
- (773) 296-3390
- Fax
- (773) 296-7531
- NPI assigned
- Jul 14, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | 59517 | TN | |
| Surgery Physician | 208600000X | 036-117220 | IL | |
| Surgery Physician | 208600000X | 036117220 | IL | |
| Vascular Surgery Physician | 2086S0129X | 036-117220 | IL | Primary |
Addresses
Primary practice location
3000 N. Halsted St.
Suite 703
Chicago, IL 60657
Mailing address
29373 Network PL
Chicago, IL 60673-1293
Phone (847) 390-5900
Other practice location 1
1325 Eastmoreland Ave Ste 365
Memphis, TN 38104-7542
Phone (901) 272-6018
Electronic endpoints 3
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | ABILITY Network |
| Direct Messaging Address | mkeldahl205985@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Vascular Surgery
- Education
- Rush Medical College of Rush University, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1775 Dempster St
Park Ridge, IL 60068-1143
214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160
3000 N Halsted St
Suite 820
Chicago, IL 60657-6185
Phone (773) 296-7150
3815 Highland Ave
Downers Grove, IL 60515-1500
836 W Wellington
Suite G346
Chicago, IL 60657-5147
Phone (773) 296-7147
836 W Wellington Ave
Chicago, IL 60657-5147
Hospital & facility affiliations
- Advocate Home Health Care Serv
- Advocate Illinois Masonic Medical Center
- Advocate Good Samaritan Hospital
- Advocate Lutheran General Hospital
- Advocate Trinity Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Spinal fusion | 1-10 |
| Varicose vein removal | 12 |
| Leg revascularization (restoring blood flow) | 11 |
| Removal of tissue | 87 |
| Removal of skin lesions | 30 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-117220 | IL | MD | Surgery Physician |
| 036117220 | IL | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advocate Health and Hospitals Corporation | Current | Accepting new patients | |
| Advocate Health and Hospitals Corporation | Current | Accepting new patients | |
| Advocate North Side Health Network | Past | Accepting new patients |
Locations
595 William R Latham SR Dr
Bourbonnais, IL 60914
Phone (815) 932-8944
214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160
135 N Arlington Heights Rd
Buffalo Grove, IL 60089
Phone (847) 215-8866
75 Remittance Dr
Chicago, IL 60675
3000 N Halsted St
Ste 703
Chicago, IL 60657
Phone (773) 296-6666
3000 N Halsted St
Ste 509
Chicago, IL 60657
Phone (773) 296-3390
1301 E 47th St
Chicago, IL 60653
Phone (773) 493-8212
29373 Network Pl
Chicago, IL 60673
75 Remittance Dr
Dept 6994
Chicago, IL 60675
Interoperability endpoints
- mkeldahl205985@direct.myadvocateaurora.org
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Oak Brook, IL
- NPI 1700824455
-
- Children's Hospital
- Oak Lawn, IL
- NPI 1508315516
-
- Clinic/Center
- Chicago, IL
- NPI 1780788323
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Park Ridge, IL
- NPI 1164539730
-
- General Acute Care Hospital
- Hazel Crest, IL
- NPI 1467560128
-
- General Acute Care Hospital
- Chicago, IL
- NPI 1558479212
-
- General Acute Care Hospital
- Downers Grove, IL
- NPI 1578670543
-
- General Acute Care Hospital
- Chicago, IL
- NPI 1912014564
-
- Home Health Agency
- Oak Brook, IL
- NPI 1598732075
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782345600000",
"number": "1114181658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29373 NETWORK PL",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606731293",
"telephone_number": "847-390-5900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 N. HALSTED ST.",
"address_2": "SUITE 703",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60657",
"telephone_number": "773-296-3390",
"fax_number": "773-296-7531"
}
],
"practiceLocations": [
{
"address_1": "1325 Eastmoreland Ave Ste 365",
"address_purpose": "LOCATION",
"city": "Memphis",
"state": "TN",
"postal_code": "381047542",
"country_code": "US",
"telephone_number": "901-272-6018",
"fax_number": "901-201-4203",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KELDAHL",
"first_name": "MARK",
"middle_name": "LOREN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-14",
"last_updated": "2026-06-25",
"certification_date": "2026-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "TN",
"license": "59517",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "036-117220",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "036117220",
"primary": false
},
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "IL",
"license": "036-117220",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"affiliationName": "ABILITY Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "64 S Price Rd Ste B",
"city": "Brownsville",
"state": "TX",
"country_code": "US",
"postal_code": "785212459",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mkeldahl205985@direct.myadvocateaurora.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "3000 N Halsted St Ste 509",
"city": "Chicago",
"state": "IL",
"country_code": "US",
"postal_code": "606575194",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "3000 N Halsted St Ste 509",
"city": "Chicago",
"state": "IL",
"country_code": "US",
"postal_code": "606575194",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.