Provider Demographics
NPI:1518991074
Name:PLUNKETT, MARK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:PLUNKETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 NE GLEN OAK AVE STE 301
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3169
Mailing Address - Country:US
Mailing Address - Phone:309-655-3453
Mailing Address - Fax:309-624-3852
Practice Address - Street 1:420 NE GLEN OAK AVE STE 301
Practice Address - Street 2:SUITE 301
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3169
Practice Address - Country:US
Practice Address - Phone:309-655-3453
Practice Address - Fax:309-624-3852
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY42233208G00000X
GA86428208G00000X
IL036-093440208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G809460Medicaid
KY7100053080Medicaid
CA00G809460Medicaid
KY7100053080Medicaid