Provider Demographics
NPI:1740256700
Name:BAYLOR, MARK C (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:C
Last Name:BAYLOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:120 W MAIN STREET
Mailing Address - Street 2:PO BOX 680
Mailing Address - City:ELMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61529
Mailing Address - Country:US
Mailing Address - Phone:309-742-2921
Mailing Address - Fax:309-742-8411
Practice Address - Street 1:120 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:IL
Practice Address - Zip Code:61529
Practice Address - Country:US
Practice Address - Phone:309-742-2921
Practice Address - Fax:309-742-8411
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069541207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069541Medicaid
ILIL0102OtherJOHN DEERE
IL7200613OtherBCBS OF ILLINOIS
IL001414OtherHEALTH ALLIANCE
IL198663OtherHEALTHLINK
GA80153581OtherRR MEDICARE
GA80153581OtherRR MEDICARE
IL198663OtherHEALTHLINK