IndividualActive
Mark Phillips, MD
NPI 1366441644 · Sports Medicine (Orthopaedic Surgery) Physician · Peoria, IL
Provider details
- NPI number
- 1366441644
- Entity type
- Individual
- Primary specialty
- Sports Medicine (Orthopaedic Surgery) PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 36067854 (IL)
Practice location
303 N William Kumpf Blvd
Peoria, IL 61605-2507
Phone: (309) 676-5546
Fax: (309) 676-5045
Mailing address
303 N William Kumpf Blvd
Peoria, IL 61605-2507
Registry dates
- Enumerated
- 2005-07-19
- Last updated
- 2026-04-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.