Individual
MARK ALLEN NEKOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3990 N ILLINOIS ST, SWANSEA, IL 62226-1919
(618) 277-1130
(618) 277-4917
Mailing address
4900 W MAIN ST, BELLEVILLE, IL 62226-4725
(618) 235-2400
(618) 235-0900
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036092365
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036092365
—
IL
01
—
08215191
BCBS
IL
01
—
18007717
RR MEDICARE
—
Enumeration date
09/27/2005
Last updated
09/09/2014
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