Individual
MARK TIMOTHY MONAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
403 E 1ST ST, DIXON, IL 61021-3116
(815) 288-5531
(815) 285-5558
Mailing address
403 E 1ST ST, DIXON, IL 61021-3116
(815) 288-5531
(815) 285-5558
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01057437A
IN
207P00000X
Emergency Medicine Physician
Primary
036107925
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000282214
ANTHEM PIN
IN
01
—
036109925
PHYSICIAN LICENSE
IL
05
—
200432460
—
IN
05
—
4782693
—
MI
Enumeration date
07/06/2006
Last updated
08/05/2025
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