Mark Loren Keldahl
Surgeon Vascular Surgeon
3000 N. Halsted St. Suite 703
Chicago
, Illinois 60657
Mark Loren Keldahl
Surgeon Vascular Surgeon
3000 N. Halsted St. Suite 703
Chicago
, Illinois 60657
(773) 296-7531
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About
Features
Specialties
- Surgeon
- Vascular Surgeon
Languages spoken
- English
Location
First Address
- Mark Loren Keldahl
- 3000 N. Halsted St. Suite 703
- Chicago, IL
- Zip : 60657
- Fax : (773) 296-7531
- Phone : (773) 296-3390
Second Address
- Mark Loren Keldahl
- 3000 N. Halsted St. Suite 703
- Chicago, IL
- Zip : 60657
- Fax : (773) 296-7531
- Phone : (773) 296-3390
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208200000X | Surgeon | 036-117220 | IL |
| Y | 208600000X | Surgeon | 036-117220 | IL |
| N | 208200000X | Surgeon | 036117220 | IL |
| N | 208600000X | Surgeon | 036117220 | IL |
| N | 2086S0129X | Vascular Surgeon | 59517 | TN |
National Provider Identifier
| NPI | 1114181658 |
|---|---|
| Provider Name | Mark Loren Keldahl |
| First Address | Chicago, IL 60657 |
| Second Address | Chicago, IL 60657 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 14/07/2008 |
| Last Update Date | 29/12/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.