Provider Demographics
NPI:1992806509
Name:GILLIS, MARK CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:GILLIS
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:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:1300 N ARLINGTON HEIGHTS RD STE 130
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-3128
Practice Address - Country:US
Practice Address - Phone:847-871-4540
Practice Address - Fax:847-871-4597
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078671Medicaid
399980OtherMEDICARE GROUP PTAN
IL214338Medicare PIN
IL214338Medicare PIN
IL01623802OtherBCBS
IL01623802OtherBCBS