Provider Demographics
NPI:1568686277
Name:KNEPP, MARC DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:DOUGLAS
Last Name:KNEPP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 NE GLEN OAK AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3105
Mailing Address - Country:US
Mailing Address - Phone:309-655-3453
Mailing Address - Fax:309-655-3410
Practice Address - Street 1:420 NE GLEN OAK AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3105
Practice Address - Country:US
Practice Address - Phone:309-655-3456
Practice Address - Fax:309-655-3410
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2022-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301083662390200000X, 207R00000X, 208000000X
IL036-1298462080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics