| Mark Ambrose, PA-C | |
|
3330 W 177th St, Suite 3e, Hazel Crest, IL 60429-2184 | |
| (708) 206-0010 | |
| (708) 206-0020 |
| Full Name | Mark Ambrose |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 3330 W 177th St, Hazel Crest, Illinois |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043424740 | NPI | - | NPPES |
| K18310SC | Other | IL | PROVIDER NO. |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 085000830 (Illinois) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Ambrose, PA-C 16450 104th Ave, Ste 101, Orland Park, IL 60467-5416 Ph: (708) 206-0010 | Mark Ambrose, PA-C 3330 W 177th St, Suite 3e, Hazel Crest, IL 60429-2184 Ph: (708) 206-0010 |
Natalie Ann Noonan, Physician Assistant Medicare: Medicare Enrolled Practice Location: 3330 W 177th St Ste 1a, Hazel Crest, IL 60429 Phone: 708-799-1100 Fax: 708-647-6503 | |
Joseph Gawlak, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 17800 Kedzie Ave, Hazel Crest, IL 60429 Phone: 708-799-8000 | |
Sydney Roth, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 17850 Kedzie Ave Ste 2200, Hazel Crest, IL 60429 Phone: 708-575-4411 Fax: 708-799-8001 |