MARK S TRAVIS (NPI# 1083690093) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083690093 |
| Entity Type | Individual |
| Full Name | MARK S TRAVIS |
| Credential | MD |
| Practice Address |
1229 N North Branch St Suite 210 Chicago IL 60622-2473 |
| Practice Telephone | 3129395090 |
| Practice Fax Number | 3126404496 |
| Mailing Telephone | 3129395090 |
| Mailing Fax Number | 3126404496 |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2007-08-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 01061315A | IN | Allopathic & Osteopathic Physicians |
| N | 207RN0300X |
Internal Medicine Specialization: Nephrology |
01061315A | IN | Allopathic & Osteopathic Physicians |
| Y | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | ANTHEM PROVIDER NUMBER | 000000383791 | 01 |
| IN | LICENSE NUMBER | 01061315A | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083255749 | Mark Wilson Travis | Marriage & Family Therapist | 345 Knechtel Way Ne Ste 111, Bainbridge Island, WA 98110-2834 | 2019-10-03 |
| 1598772329 | Mark H Travis | Optometrist | 4687 Stonewall Xing, Springdale, AR 72764-8579 | 2006-08-02 |
| 1558593236 | Mark Travis | Counselor | 8561 Fenton St, Ste 230, Silver Spring, MD 20910-4455 | 2009-08-14 |
| 1699862540 | Mark Clarence Travis | Counselor | 250 S Henry St, Delaware, OH 43015-2978 | 2006-10-10 |
| 1760455281 | Mark Douglas Travis | Radiology | One Hospital Drive, Columbia, MO 65212-0001 | 2006-02-08 |
| Street Address |
1229 N NORTH BRANCH ST SUITE 210 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60622-2473 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376528802 | J. Romaine Roberts | Anesthesiology | 1229 N North Branch St, Chicago, IL 60642-2473 | 2005-12-07 |
| 1689098766 | Targol Christie Esmaili | Podiatrist | 1229 N North Branch St, Ste 308, Chicago, IL 60642-2496 | 2014-02-11 |
| 1851729370 | Midwest Podiatric Physicians, P.C. | Podiatrist | 1229 N North Branch St, Ste 308, Chicago, IL 60642-2473 | 2013-10-18 |
| 1770887408 | Sujin G Kim | Podiatrist | 1229 N North Branch St, Suite 308, Chicago, IL 60642-2473 | 2011-01-10 |
| 1639322662 | Antoni A Piergies | Internal Medicine | 1229 N North Branch St, Suite 210, Chicago, IL 60642-2473 | 2008-11-04 |
| 1376793737 | Alan L. Sisson | Emergency Medicine | 1229 N North Branch St, Suite 210, Chicago, IL 60642-2473 | 2008-09-23 |
| 1083875256 | Andrea Luisa Peach | Podiatrist | 1229 N North Branch St, Suite 210, Chicago, IL 60642-2473 | 2008-06-20 |
| 1629259809 | Glenn M Winter | Internal Medicine | 1229 N North Branch St, Suite 210, Chicago, IL 60622-2473 | 2007-11-16 |
| 1699960690 | Douglas John Frohlich I | Family Medicine | 1229 N North Branch St, Suite 210, Chicago, IL 60622-2473 | 2007-09-12 |
| 1326233735 | Mobile Doctors Management | Internal Medicine | 1229 N North Branch St, Suite 210, Chicago, IL 60622-2473 | 2007-09-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447880471 | Erikson Institute | Clinic/Center | 2739 W Division St, Chicago, IL 60622 | 2020-01-17 |
| 1720620545 | Emily Claire Bonanno | Counselor | 1397 N Miwaukee Ave, Chicago, IL 60622 | 2019-10-14 |
| 1891342093 | Taylor Mallon | Speech-Language Pathologist | 8870 South Duffy Avenue, Apartment 406, Chicago, IL 60622 | 2019-08-22 |
| 1083260277 | Maggie Inman | Student in an Organized Health Care Education/Training Program | 1431 N Claremont Avenue, 2nd Floor Pavilion, Chicago, IL 60622 | 2019-08-13 |
| 1174176168 | Karol Maricel Quelal Analuisa | Internal Medicine | 1901 W Harrison, Chicago Il 60612-3714, Chicago, IL 60622 | 2019-07-19 |
| 1073076105 | Nichole Galullo | Social Worker | 1431 N Claremont 2nd Floor, Chicago, IL 60622 | 2019-04-06 |
| 1003375122 | Alfredo Delgado Perez Sr. | Psychologist | 1127 N Oakley Bvl 3 Floor, Chicago, IL 60622 | 2019-03-18 |
| 1841773439 | Abigail Hector | Counselor | 1521 N Milwaukee Ave, 3n, Chicago, IL 60622 | 2018-09-11 |
| 1164916144 | Dorothy Mitkowski | Student in an Organized Health Care Education/Training Program | 1127 N. Oakley Blvd., 2nd Floor, Chicago, IL 60622 | 2018-06-21 |
| 1255825121 | Kara Lynn Daniel | Speech-Language Pathologist | 1540 N Artesian Ave Apt 2r, Chicago, IL 60622 | 2018-06-14 |
| Find all providers in zip 60622 | ||||
| Taxonomy Code | 207RG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Geriatric Medicine |
| An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477058378 | Ranim Mira | Internal Medicine | 4021 W Belle Plaine Ave # Ge, Chicago, IL 60641-2412 | 2018-03-24 |
| 1518351758 | Vania Leung | Internal Medicine | 2600 S Michigan Ave Ste 205, Chicago, IL 60616-2857 | 2015-03-25 |
| 1699174540 | Hatem Hassaballa | Internal Medicine | 840 S Wood St Fl 4, Suite 409 (m/c 717), Chicago, IL 60612-4325 | 2014-08-16 |
| 1609037498 | Katya Yanira Cruz Madrid | Internal Medicine | 840 S. Wood St, Mic 717 Suite 409, Chicago, IL 60612 | 2008-06-24 |
| 1114113271 | Ewa Nowak | Internal Medicine | 3319 N Elston Ave # 200, Chicago, IL 60618-5811 | 2007-09-21 |
| 1275735706 | Geraldine Luna | Internal Medicine | 2231 E 95th St, Chicago, IL 60617-4804 | 2007-06-05 |
| 1487864542 | Kyra Payne | Internal Medicine | 213 N Racine, #100, Chicago, IL 60607 | 2007-05-23 |
| 1669699716 | Alejandro Aparicio | Internal Medicine | 6512 W Belle Plaine Ave, Chicago, IL 60634-1434 | 2007-04-19 |
| 1154459840 | Patricia Anne Rush | Internal Medicine | 7101 S Exchange Ave, Chicago, IL 60649-2503 | 2007-03-02 |
| 1447313705 | Shellie N Williams | Internal Medicine | The University of Chicago, 5841 S. Maryland Ave. Mc 6098, Chicago, IL 60637 | 2006-12-18 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.