| Doctor Name: | DR. MARK ANDREW FENLON |
| NPI Number: | 1043341068 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M. |
| License Number: | 16-004799 |
| Business Practice Address: | 12620 S Harlem Ave Palos Heights, IL - 604631428 |
| Business Phone Number: | 7083613338 |
| Business Fax Number: | 7083613748 |
| Mailing Address: | 12620 S Harlem Ave, PALOS HEIGHTS |
| State: | IL |
| Postal Code: | 604631428 |
| Phone Number: | 7083613338 |
| Fax Number: | 7083613748 |
| NPI Enumeration Date: | 03/08/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 16-004799 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |