Mahoney, John Damen

Mahoney, John Damen is an individual health care provider with primary practice located at 6000 N Allen Road , Peoria IL 61614-3294. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Mahoney, John Damen can be contacted via phone (309) 691-1400.

Contact Information

Primary practice address
6000 N Allen Road Peoria IL 61614-3294
Phone: (309) 691-1400
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 0361156696 Illinois

Profile Details

NPI number 1093767659
LBN Legal business name Mahoney, John Damen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 16th, 2006
Last updated Dec 31st, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093767659 NPPES
Illinois MEDICAID 036115669

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