Individual
DR. MARK PHILLIP GAUDIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-6710
Mailing address
104 WILDFLOWER AVE, METAMORA, IL 61548-8656
(309) 383-2044
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-121441
IL
207P00000X
Emergency Medicine Physician
125-051037
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
809840
GROUP MEDICARE NUMBER
IL
01
—
809840036
INDIVIDUAL MEDICARE NUMBER
IL
Enumeration date
06/05/2007
Last updated
12/10/2021
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