Fernandez, Mark Allen
Fernandez, Mark Allen is an individual health care provider with primary practice located at 920 West St Ste 311, Peru IL 61354-2770. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Fernandez, Mark Allen can be contacted via phone (815) 223-9214.Contact Information
Primary practice address
920 West St Ste 311
Peru IL 61354-2770
Phone: (815) 223-9214
Fax: (815) 223-9322
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 036-089936 | Illinois |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 036089936 | Illinois |
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | 036089936 | Illinois |
Profile Details
| NPI number | 1033114939 |
|---|---|
| LBN Legal business name | Fernandez, Mark Allen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 16th, 2005 |
| Last updated | Nov 20th, 2008 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1033114939 | NPPES |
| Illinois | MEDICAID | 036089936 |
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