Phillips, Mark R

Phillips, Mark R is an individual health care provider with primary practice located at 303 N William Kumpf Blvd , Peoria IL 61605-2507. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Phillips, Mark R can be contacted via phone (309) 676-5546.

Contact Information

Primary practice address
303 N William Kumpf Blvd Peoria IL 61605-2507
Phone: (309) 676-5546
Fax: (309) 676-5045
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 36067854 Illinois

Profile Details

NPI number 1366441644
LBN Legal business name Phillips, Mark R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2005
Last updated Dec 4th, 2009 - about 17 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 1366441644 NPPES
Illinois MEDICAID 36067854

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