DR. MARK EDWIN CARLSON (NPI# 1790741049) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790741049 |
| Entity Type | Individual |
| Full Name | DR. MARK EDWIN CARLSON |
| Credential | MD |
| Practice Address |
1848 Daimler Rd Rockford IL 61112-1019 |
| Practice Telephone | 8153989100 |
| Practice Fax Number | 8159866770 |
| Mailing Telephone | 8153989100 |
| Mailing Fax Number | 8159866770 |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2010-09-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 036-073115 | IL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 36073065 | 05 | |
| IL | MEDICARE PTAN | K52428 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861935082 | Mark Andrew Carlson | Contractor | 29822 Windwood Cir, Temecula, CA 92591-2807 | 2016-11-19 |
| 1265661243 | Mark Frederick Carlson | Speech-Language Pathologist | 1603 Ne 52nd Ave, Portland, OR 97213-2725 | 2009-07-10 |
| 1205095759 | Mark Kent Carlson | Chiropractor | 9437 Ironwood Dr, Frisco, TX 75034-1254 | 2008-06-09 |
| 1851449318 | Mark A. Carlson | Family Medicine | 1400 E. Kincade Street, Mount Vernon, WA 98274-4127 | 2007-01-08 |
| 1184736498 | Mark D Carlson | Internal Medicine | 2401 S Tucker Ave Ste 1, Pittsburg, KS 66762-6619 | 2006-08-31 |
| 1083670780 | Mark David Carlson | Dentist | 1550 South Union Avenue, Suite 250, Tacoma, WA 98405-1946 | 2006-04-22 |
| 1609837368 | Mark O. Carlson | Internal Medicine | 1605 Douglas St, Sioux City, IA 51105-1109 | 2006-03-31 |
| 1023008398 | Mark D Carlson | Family Medicine | 1905 S Lakeline Blvd Ste 4, Cedar Park, TX 78613 | 2005-10-26 |
| 1801437694 | Mark Carlson | Chiropractor | 2377 Cumberland Square Dr, Bettendorf, IA 52722-3251 | 2019-10-02 |
| 1073887444 | Mark Anthony Carlson | Pharmacist | 66 Birdsong Pkwy, Orchard Park, NY 14127-3068 | 2012-03-02 |
| Street Address |
1848 DAIMLER RD |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61112-1019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811303217 | Kelly L Magoon | Physician Assistant | 1848 Daimler Rd, Rockford, IL 61112-1019 | 2014-07-07 |
| 1649444548 | Regional Cardiology Consultants Ltd | Specialist | 1848 Daimler Rd, Rockford, IL 61112-1019 | 2008-04-22 |
| 1366560773 | Catherine L Blake | Nurse Practitioner | 1848 Daimler Rd, Rockford, IL 61112-1019 | 2007-03-26 |
| 1750450243 | Vanessa Ann Dal Pra Wochner | Physical Therapist | 1848 Daimler Rd, Rockford, IL 61112-1019 | 2006-11-07 |
| 1245342666 | Carlson Orthopedic Clinic Sc | Specialist | 1848 Daimler Rd, Rockford, IL 61112-1019 | 2006-08-31 |
| 1013930353 | Physician Associates Limited | Family Medicine | 1848 Daimler Rd, Rockford, IL 61112-1019 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215213475 | Matthew Caleb Beary | Physical Therapist | 1545 Temple Lane, Rockford, IL 61112 | 2011-11-01 |
| 1730469206 | Herman Chen | Pharmacist | 2206 Barnes Blvd, Rockford, IL 61112 | 2011-08-27 |
| 1598850273 | Charles W Matty | Dentist | 1855 Daimler Rd, Rockford, IL 61112 | 2006-10-04 |
| 1942317607 | James Edward Nijoka | Dentist | 1855 Daimler Road, Rockford, IL 61112 | 2006-08-25 |
| 1053366591 | Vincent R Facchiano | Optometrist | E265 Cherryvale Mall, Rockford, IL 61112 | 2006-05-23 |
| 1780616029 | Daniel Gordon Thorstenson | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2006-07-07 |
| 1760800221 | Brock Stephen Field | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2014-04-02 |
| 1629366489 | Craig Anthony Stear Jr. | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2011-07-14 |
| 1104931427 | Hulsebus Rockford Chiropractic | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2006-08-19 |
| 1215958970 | Michael John Hulsebus | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2006-07-21 |
| Find all providers in zip 61112 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053615054 | Lisa Diane Kehoe | Specialist | 1745 Williamsburg Rd, Rockford, IL 61107-2445 | 2011-01-05 |
| 1134445489 | Sanford Bruce Mer | Specialist | 3008 Spring Creek Rd, Rockford, IL 61107-1061 | 2010-04-12 |
| 1225351935 | Rhiannon Marie Deyoung | Specialist | 8450 Algoma Ave Ne Ste Aaa, Rockford, MI 49341-7508 | 2010-03-09 |
| 1689900169 | Jacqueline Michele Sharp | Specialist | 2204 Arthur Ave, Rockford, IL 61101-5224 | 2009-10-19 |
| 1184869893 | Joseph Gerard Lynch | Specialist | 8081 Ravenrock Rd, Rockford, MN 55373-9394 | 2008-12-09 |
| 1548438344 | Helen Wiedemer Laib | Specialist | 4804 Innsbruck Dr, Rockford, IL 61114-7312 | 2008-02-14 |
| 1962609859 | Sandra Rebecca Hallman | Specialist | 6017 Abington Dr, Rockford, IL 61109-2757 | 2007-07-02 |
| 1558481366 | Mark Theodore Peterson | Specialist | 5712 Newburg Rd, Rockford, IL 61108-6707 | 2007-03-29 |
| 1801913769 | Megan D Lindley | Specialist | 610 Vale Ave, Rockford, IL 61107-4656 | 2007-03-24 |
| 1841335072 | Ob-gyn Associates (rockford) Ltd. | Specialist | 1016 Featherstone Road, Rockford Ambulatory Surgery Center, Rockford, IL 61107 | 2007-02-21 |
| Find all providers in ROCKFORD | ||||
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| 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.