Provider Demographics
NPI:1124088497
Name:LOVELL, MARK EUGENE (ATC/L)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:EUGENE
Last Name:LOVELL
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LINDEN LN
Mailing Address - Street 2:APT 59A
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-1074
Mailing Address - Country:US
Mailing Address - Phone:815-671-8269
Mailing Address - Fax:
Practice Address - Street 1:900 LINDEN LN
Practice Address - Street 2:APT 59A
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-1074
Practice Address - Country:US
Practice Address - Phone:815-671-8269
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine