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Mark L. Lundine M.D. P.C.

Otolaryngology, Facial Plastic Surgery in Rockford, IL. Organization (NPI-2).

NPI number1316138522
StatusActive
Last updated in NPPESOct 28, 2007

Details

NPI
1316138522
Entity type
Organization (NPI-2)
Legal business name
Mark L. Lundine M.D. P.C.
Organization subpart
No
Enumeration date
Aug 5, 2007
Last updated
Oct 28, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207YS0123X Otolaryngology, Facial Plastic Surgery336023733ILYes

Practice location

6979 Redansa Dr
Rockford, IL 61108-1201

Phone 815-226-1800

Mailing address

6979 Redansa Dr
Rockford, IL 61108-1201

Authorized official

Mark L Lundine
President
8152261800

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