Provider Demographics
NPI:1104133487
Name:SESKE, MARK DOUGLAS (MS)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:DOUGLAS
Last Name:SESKE
Suffix:
Gender:M
Credentials:MS
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Mailing Address - Street 1:5225 OLD ORCHARD RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4405
Mailing Address - Country:US
Mailing Address - Phone:847-663-1020
Mailing Address - Fax:847-663-1022
Practice Address - Street 1:5225 OLD ORCHARD RD
Practice Address - Street 2:SUITE 18
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4405
Practice Address - Country:US
Practice Address - Phone:847-663-1020
Practice Address - Fax:847-663-1022
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL056009206225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist