Provider Demographics
NPI:1922094002
Name:ALLENDORPH, MARK M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:ALLENDORPH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2 MEMORIAL DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6723
Mailing Address - Country:US
Mailing Address - Phone:618-465-5849
Mailing Address - Fax:618-465-5853
Practice Address - Street 1:2 MEMORIAL DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6723
Practice Address - Country:US
Practice Address - Phone:618-465-5849
Practice Address - Fax:618-465-5853
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2008-05-27
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Provider Licenses
StateLicense IDTaxonomies
IL036072597207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL584350Medicare PIN