Stivers, Mark
Stivers, Mark is an individual health care provider with primary practice located at 207 E Hamilton Rd , Bloomington IL 61704-7527. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Stivers, Mark can be contacted via phone (309) 827-4090.Contact Information
Primary practice address
207 E Hamilton Rd
Bloomington IL 61704-7527
Phone: (309) 827-4090
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 036.141995 | Illinois |
Profile Details
| NPI number | 1417943523 |
|---|---|
| LBN Legal business name | Stivers, Mark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 23rd, 2005 |
| Last updated | Jun 8th, 2022 - about 3 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 | 1417943523 | NPPES |
| Arizona | MEDICAID | 866220 |
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