Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0316111485 | IL |
N | 208600000X | Surgeon | 0316111485 | IL |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 0316111485 | IL |
NPI | 1245498658 |
---|---|
Provider Name | Dr. Mark Sisco |
First Address | Northbrook, IL 60062-2802 |
Second Address | Northbrook, IL 60062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 11/02/2021 |