Individual
MARC R. DEJONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 N 1ST ST, SPRINGFIELD, IL 62702-3719
(217) 528-7541
(217) 527-1103
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
(217) 528-8962
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036114259
IL
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
036114259
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036114259
—
IL
Enumeration date
09/23/2005
Last updated
05/22/2020
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