Individual
DR. MARK R PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
303 N WILLIAM KUMPF BLVD, PEORIA, IL 61605-2507
(309) 676-5546
(309) 676-5045
Mailing address
303 N WILLIAM KUMPF BLVD, PEORIA, IL 61605-2507
(309) 676-5546
(309) 676-5045
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
36067854
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36067854
—
IL
Enumeration date
07/19/2005
Last updated
04/26/2026
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