Provider Demographics
NPI:1750588661
Name:THOMPSON, MARK ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALBERT
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:2301 E 93RD ST STE 115
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3986
Practice Address - Country:US
Practice Address - Phone:708-799-8700
Practice Address - Fax:708-957-1830
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2000753207R00000X
LAMD.200753207RC0000X
TXP2545207RC0000X
IL036.151584207RC0000X
IL125050537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06521751Medicaid
TX311313601Medicaid
TX8DK391OtherBCBS
LA1070866Medicaid
TXTXB160487Medicare PIN
TX8DK391OtherBCBS
LA1070866Medicaid