Active NPI
Gregory Karl Mork, D.O.
- Diagnostic Radiology Physician
- Waukegan, IL
National Provider Identifier
1720222193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 52821-021
- Practice address
- 1324 N Sheridan Rd
Vista Medical Center
Waukegan, IL 60085-2161 - Phone
- (847) 360-4189
- Fax
- (847) 360-4013
- NPI assigned
- Apr 28, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 52821-021 | WI | Primary |
Addresses
Primary practice location
1324 N Sheridan Rd
Vista Medical Center
Waukegan, IL 60085-2161
Mailing address
1324 N Sheridan Rd
Vista Medical Center
Waukegan, IL 60085-2161
Phone (847) 360-4189
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52821-021 | WI | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281398400000",
"number": "1720222193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1324 N SHERIDAN RD",
"address_2": "VISTA MEDICAL CENTER",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600852161",
"telephone_number": "847-360-4189",
"fax_number": "847-360-4013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1324 N SHERIDAN RD",
"address_2": "VISTA MEDICAL CENTER",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600852161",
"telephone_number": "847-360-4189",
"fax_number": "847-360-4013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORK",
"first_name": "GREGORY",
"middle_name": "KARL",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-28",
"last_updated": "2010-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "WI",
"license": "52821-021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.