MARK S TRAVIS


Address: 1229 N North Branch St, Suite 210, Chicago, IL 60622-2473
Phone: 3129395090

MARK S TRAVIS (NPI# 1083690093) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1083690093
Entity Type Individual
Full Name MARK S TRAVIS
Credential MD
Practice Address 1229 N North Branch St
Suite 210
Chicago
IL 60622-2473
Practice Telephone 3129395090
Practice Fax Number 3126404496
Mailing Telephone 3129395090
Mailing Fax Number 3126404496
Enumeration Date 2005-12-21
Last Update Date 2007-08-01
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207R00000X Internal Medicine 01061315A IN Allopathic & Osteopathic Physicians
N 207RN0300X Internal Medicine
Specialization: Nephrology
01061315A IN Allopathic & Osteopathic Physicians
Y 207RG0300X Internal Medicine
Specialization: Geriatric Medicine
IL Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
IN ANTHEM PROVIDER NUMBER 000000383791 01
IN LICENSE NUMBER 01061315A 01

Other Providers MARK TRAVIS

NPI Name Taxonomy Address Enumeration
1083255749 Mark Wilson Travis Marriage & Family Therapist 345 Knechtel Way Ne Ste 111, Bainbridge Island, WA 98110-2834 2019-10-03
1598772329 Mark H Travis Optometrist 4687 Stonewall Xing, Springdale, AR 72764-8579 2006-08-02
1558593236 Mark Travis Counselor 8561 Fenton St, Ste 230, Silver Spring, MD 20910-4455 2009-08-14
1699862540 Mark Clarence Travis Counselor 250 S Henry St, Delaware, OH 43015-2978 2006-10-10
1760455281 Mark Douglas Travis Radiology One Hospital Drive, Columbia, MO 65212-0001 2006-02-08

Office Location

Street Address 1229 N NORTH BRANCH ST
SUITE 210
City CHICAGO
State IL
Zip Code 60622-2473

Providers in the same location

NPI Name Taxonomy Address Enumeration
1376528802 J. Romaine Roberts Anesthesiology 1229 N North Branch St, Chicago, IL 60642-2473 2005-12-07
1689098766 Targol Christie Esmaili Podiatrist 1229 N North Branch St, Ste 308, Chicago, IL 60642-2496 2014-02-11
1851729370 Midwest Podiatric Physicians, P.C. Podiatrist 1229 N North Branch St, Ste 308, Chicago, IL 60642-2473 2013-10-18
1770887408 Sujin G Kim Podiatrist 1229 N North Branch St, Suite 308, Chicago, IL 60642-2473 2011-01-10
1639322662 Antoni A Piergies Internal Medicine 1229 N North Branch St, Suite 210, Chicago, IL 60642-2473 2008-11-04
1376793737 Alan L. Sisson Emergency Medicine 1229 N North Branch St, Suite 210, Chicago, IL 60642-2473 2008-09-23
1083875256 Andrea Luisa Peach Podiatrist 1229 N North Branch St, Suite 210, Chicago, IL 60642-2473 2008-06-20
1629259809 Glenn M Winter Internal Medicine 1229 N North Branch St, Suite 210, Chicago, IL 60622-2473 2007-11-16
1699960690 Douglas John Frohlich I Family Medicine 1229 N North Branch St, Suite 210, Chicago, IL 60622-2473 2007-09-12
1326233735 Mobile Doctors Management Internal Medicine 1229 N North Branch St, Suite 210, Chicago, IL 60622-2473 2007-09-10
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1447880471 Erikson Institute Clinic/Center 2739 W Division St, Chicago, IL 60622 2020-01-17
1720620545 Emily Claire Bonanno Counselor 1397 N Miwaukee Ave, Chicago, IL 60622 2019-10-14
1891342093 Taylor Mallon Speech-Language Pathologist 8870 South Duffy Avenue, Apartment 406, Chicago, IL 60622 2019-08-22
1083260277 Maggie Inman Student in an Organized Health Care Education/Training Program 1431 N Claremont Avenue, 2nd Floor Pavilion, Chicago, IL 60622 2019-08-13
1174176168 Karol Maricel Quelal Analuisa Internal Medicine 1901 W Harrison, Chicago Il 60612-3714, Chicago, IL 60622 2019-07-19
1073076105 Nichole Galullo Social Worker 1431 N Claremont 2nd Floor, Chicago, IL 60622 2019-04-06
1003375122 Alfredo Delgado Perez Sr. Psychologist 1127 N Oakley Bvl 3 Floor, Chicago, IL 60622 2019-03-18
1841773439 Abigail Hector Counselor 1521 N Milwaukee Ave, 3n, Chicago, IL 60622 2018-09-11
1164916144 Dorothy Mitkowski Student in an Organized Health Care Education/Training Program 1127 N. Oakley Blvd., 2nd Floor, Chicago, IL 60622 2018-06-21
1255825121 Kara Lynn Daniel Speech-Language Pathologist 1540 N Artesian Ave Apt 2r, Chicago, IL 60622 2018-06-14
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Taxonomy Information

Taxonomy Code 207RG0300X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Geriatric Medicine

Taxonomy Definition

An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1477058378 Ranim Mira Internal Medicine 4021 W Belle Plaine Ave # Ge, Chicago, IL 60641-2412 2018-03-24
1518351758 Vania Leung Internal Medicine 2600 S Michigan Ave Ste 205, Chicago, IL 60616-2857 2015-03-25
1699174540 Hatem Hassaballa Internal Medicine 840 S Wood St Fl 4, Suite 409 (m/c 717), Chicago, IL 60612-4325 2014-08-16
1609037498 Katya Yanira Cruz Madrid Internal Medicine 840 S. Wood St, Mic 717 Suite 409, Chicago, IL 60612 2008-06-24
1114113271 Ewa Nowak Internal Medicine 3319 N Elston Ave # 200, Chicago, IL 60618-5811 2007-09-21
1275735706 Geraldine Luna Internal Medicine 2231 E 95th St, Chicago, IL 60617-4804 2007-06-05
1487864542 Kyra Payne Internal Medicine 213 N Racine, #100, Chicago, IL 60607 2007-05-23
1669699716 Alejandro Aparicio Internal Medicine 6512 W Belle Plaine Ave, Chicago, IL 60634-1434 2007-04-19
1154459840 Patricia Anne Rush Internal Medicine 7101 S Exchange Ave, Chicago, IL 60649-2503 2007-03-02
1447313705 Shellie N Williams Internal Medicine The University of Chicago, 5841 S. Maryland Ave. Mc 6098, Chicago, IL 60637 2006-12-18
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Competitor

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City CHICAGO
Zip Code 60622

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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