Individual
DR. MARK T DONVITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 S HOSPITAL DR, MURPHYSBORO, IL 62966-3333
(618) 684-3156
(618) 529-0524
Mailing address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(800) 701-3381
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-077356
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036077356-4
—
IL
05
—
1073564175
—
KY
Enumeration date
05/13/2006
Last updated
01/11/2021
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