Provider Demographics
NPI:1851398663
Name:REGNIER, MARK ALAN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:REGNIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1830 MEDITERRANEAN DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3144
Mailing Address - Country:US
Mailing Address - Phone:815-899-0001
Mailing Address - Fax:815-899-0002
Practice Address - Street 1:1830 MEDITERRANEAN DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3144
Practice Address - Country:US
Practice Address - Phone:815-899-0001
Practice Address - Fax:815-899-0002
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036097453208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097453Medicaid