Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 036106547 | IL |
NPI | 1164495529 |
---|---|
Provider Name | Dr. Mark T Nolden |
First Address | Chicago, IL 60611-4546 |
Second Address | Chicago, IL 60611-4546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 16/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H47815 | (02) | IL |