Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 036-063966 | IL |
NPI | 1033201579 |
---|---|
Provider Name | Dr. Mark A. Stern |
First Address | Springfield, IL 62703-2403 |
Second Address | Springfield, IL 62702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 18/06/2020 |