Mark D Gendleman MD SC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

036045834 Issued in IL

Legal business name

MARK D GENDLEMAN MD SC

Practice address

2500 Ridge Ave Ste 103
Evanston, IL 60201-2468

Phone

(847) 475-4556

Fax

(847) 475-4565

NPI assigned

Dec 2, 2010

Last updated

Dec 2, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Gendleman, M.D.NPI 1457339863

Title

President

Phone

(847) 475-4556

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark D Gendleman, M.D.

  • Specialist
  • Evanston, IL
  • NPI 1457339863
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291248000000",
    "number": "1730481375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 RIDGE AVE STE 103",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602012468",
            "telephone_number": "847-475-4556",
            "fax_number": "847-475-4565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 RIDGE AVE STE 103",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602012468",
            "telephone_number": "847-475-4556",
            "fax_number": "847-475-4565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK D GENDLEMAN MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-02",
        "last_updated": "2010-12-02",
        "status": "A",
        "authorized_official_last_name": "GENDLEMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-475-4556",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "IL",
            "license": "036045834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maren W. Deaver, LCSW PLLC (Maren W. Deaver, LCSW LLC)
• Adam Margol, PSY.D.
• Eliezer Tzvi Margolis, PH.D.
• Maria Borzecka, DDS, Corp
• Carlos Alberto Marin, MD
• Angela Mark, MD
• Dara J Marlin
• Marlys a Conrad PHD LLC
• Deborah S Marmor, DMD
• Anne Marous, LCSW

• Exclusive Provider Organization in Evanston, IL
• Providers in Evanston, IL by specialty
• Exclusive Provider Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.

Verify at the official NPI Registry.