Provider Demographics
NPI:1306902994
Name:SHIELDS, MARK C (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:SHIELDS
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 1:1661 FEEHANVILLE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-6087
Mailing Address - Country:US
Mailing Address - Phone:847-635-4447
Mailing Address - Fax:847-298-5792
Practice Address - Street 1:1661 FEEHANVILLE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6087
Practice Address - Country:US
Practice Address - Phone:847-635-4447
Practice Address - Fax:847-298-5792
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC38000Medicare UPIN