Dejong, Marc R.

Dejong, Marc R. is an individual health care provider with primary practice located at 800 N 1St St , Springfield IL 62702-3719. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Dejong, Marc R. can be contacted via phone (217) 528-7541.

Contact Information

Primary practice address
800 N 1St St Springfield IL 62702-3719
Phone: (217) 528-7541
Fax: (217) 527-1103
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036114259 Illinois
Allopathic & Osteopathic Physicians / Sports Medicine 207RS0010X 036114259 Illinois

Profile Details

NPI number 1477549541
LBN Legal business name Dejong, Marc R.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 23rd, 2005
Last updated May 22nd, 2020 - about 5 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 1477549541 NPPES
Illinois MEDICAID 036114259

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