Provider Demographics
NPI:1801861380
Name:BISHOP, DONALD K (MD)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:K
Last Name:BISHOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-6477
Mailing Address - Country:US
Mailing Address - Phone:877-456-2496
Mailing Address - Fax:618-997-5285
Practice Address - Street 1:1390 HOPE DR
Practice Address - Street 2:SUITE B
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5306
Practice Address - Country:US
Practice Address - Phone:877-456-2496
Practice Address - Fax:618-997-5285
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087118207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCF3444OtherMEDICARE RR
IL370966854017Medicaid
IL036087118Medicaid
ILCF3444OtherMEDICARE RR
IL036087118Medicaid
IL640701Medicare PIN
ILK16500Medicare PIN