Smith, Mark Alan

Smith, Mark Alan is an individual health care provider with primary practice located at 3322 W Willow Knolls Dr , Peoria IL 61614. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Smith, Mark Alan can be contacted via phone (309) 691-5800.

Contact Information

Primary practice address
3322 W Willow Knolls Dr Peoria IL 61614
Phone: (309) 691-5800
Fax: (309) 691-1336
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 016004790 Illinois

Profile Details

NPI number 1093885378
LBN Legal business name Smith, Mark Alan
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 8th, 2006
Last updated Dec 3rd, 2009 - about 15 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1093885378 NPPES
Illinois MEDICAID 016004790
Illinois Other 0007215174
Illinois Other 928270
Illinois Other 480022534

Popular Providers