| Doctor Name: | DR. MARK S WOOD |
| NPI Number: | 1770676090 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 036.129164 |
| Business Practice Address: | 5100 Lake Ter Ne Suite Wc Mount Vernon, IL - 628649665 |
| Business Phone Number: | 6188995001 |
| Business Fax Number: | 6182425152 |
| Mailing Address: | 5100 Lake Ter Ne, Suite Wc MOUNT VERNON |
| State: | IL |
| Postal Code: | 628649665 |
| Phone Number: | 6188995001 |
| Fax Number: | 6182425152 |
| NPI Enumeration Date: | 09/30/2006 |
| NPI Last Update Date: | 06/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 036.129164 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |