MARK AMBROSE PA-C
NPI 1043424740
Physician Assistant in Hazel Crest, IL

Active since May 10, 2007
3330 W 177TH ST, SUITE 3E, HAZEL CREST, IL 60429(708) 206-0010(708) 206-0020 Get Directions Write a Review

NPPES record last updated: May 13, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mark Ambrose Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARK AMBROSE PA-C (NPI 1043424740) is an individual physician assistant in Hazel Crest, Illinois, licensed in Illinois (085000830) and active in the NPI registry since May 2007.

NPPES Registry Identity

NPI1043424740
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMARK AMBROSECredential: PA-C
Location Address3330 W 177TH ST, SUITE 3EHazel Crest, IL 60429-2184
Mailing Address16450 104th Ave, Ste 101Orland Park, IL 60467-5416 · (708) 206-0010 · Fax (708) 206-0020
Fax(708) 206-0020
Sole ProprietorNo
Enumeration DateMay 10, 2007
Last NPPES UpdateMay 13, 2016
NPI 1043424740 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in IL · 085000830
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
3330 W 177TH ST, Hazel Crest, IL 60429

Other Identifiers 2

Medicare UPINQ46010IL
OtherK18310SCIL · Provider No.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine (Geriatric Medicine)
3330 W 177TH ST, SUITE 1A
HAZEL CREST, IL 60429
Clinic/Center (Ambulatory Surgical)
3330 W 177TH ST, SUITE 2C
HAZEL CREST, IL 60429
Social Worker (Clinical)
3330 W 177TH ST, SUITE 1F
HAZEL CREST, IL 60429
Internal Medicine (Geriatric Medicine)
3330 W 177TH ST, SUITE 2E
HAZEL CREST, IL 60429
Specialist
3330 W 177TH ST, SUITE 3C
HAZEL CREST, IL 60429
Social Worker (Clinical)
3330 W 177TH ST, SUITE 1F
HAZEL CREST, IL 60429
Internal Medicine (Geriatric Medicine)
3330 W 177TH ST, SUITE 1A
HAZEL CREST, IL 60429
Pharmacy (Community/Retail Pharmacy)
3330 W 177TH ST, STE 1E
HAZEL CREST, IL 60429

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Ambrose's NPI number?

The NPI number for Mark Ambrose is 1043424740. It was assigned to this individual provider in the NPPES registry on May 10, 2007.

Where is Mark Ambrose located?

Mark Ambrose practices at 3330 W 177th St Suite 3E, Hazel Crest, IL 60429. The listed phone number is (708) 206-0010.

What is Mark Ambrose's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Mark Ambrose was last updated on May 13, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.