Provider Demographics
NPI:1285808246
Name:BEEN, MARK JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:BEEN
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 1:2800 KESLINGER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3751
Mailing Address - Country:US
Mailing Address - Phone:630-492-1226
Mailing Address - Fax:630-485-6943
Practice Address - Street 1:2800 KESLINGER RD STE 110
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134
Practice Address - Country:US
Practice Address - Phone:630-492-1226
Practice Address - Fax:630-485-6943
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYFB3752993207Y00000X
390200000X
IL036.136184207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400463517OtherMEDICARE
ILF400463517OtherMEDICARE