Individual
JOHN MARK FLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
751 N RUTLEDGE ST, SUITE 1100, SPRINGFIELD, IL 62702-4968
(217) 545-8000
(217) 545-4735
Mailing address
PO BOX 19636, SPRINGFIELD, IL 62794-9636
(217) 545-8000
(217) 545-4735
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-138254
IL
207RH0005X
Hypertension Specialist Physician
Primary
036-138254
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036138254
—
IL
Enumeration date
06/29/2006
Last updated
10/21/2020
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