Individual
DR. MARK MONTEFOLKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 E WAR MEMORIAL DR, PEORIA HEIGHTS, IL 61616
(309) 685-0100
(309) 685-0172
Mailing address
1120 E WAR MEMORIAL DR, PEORIA HEIGHTS, IL 61616
(309) 685-0100
(309) 685-0172
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036110139
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K09678
PIN
IL
Enumeration date
09/21/2006
Last updated
07/09/2007
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