Mark Allen Fernandez, M.D.
Individual provider Active NPI Internal Medicine Physician · Peru, IL
NPI 1033114939 · NPPES record last updated Nov 20, 2008
Key facts
- NPI
- 1033114939
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 036-089936 (IL)
- Practice address
- 920 West St
Ste 311
Peru, IL 61354-2770 - Phone
- (815) 223-9214
- Fax
- (815) 223-9322
- NPI assigned
- Jun 16, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-089936 | IL | MD | Internal Medicine Physician |
| 036089936 | IL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Pathology, S.C. | Current | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Locations
925 West St
Peru, IL 61354
Phone (815) 223-3300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036-089936 | IL | Yes |
| Pediatrics Physician | 208000000X | 036089936 | IL | |
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 036089936 | IL |
Addresses
Primary practice location
920 West St
Ste 311
Peru, IL 61354-2770
Mailing address
920 West St
Ste 311
Peru, IL 61354-2770
Phone (815) 223-9214
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036089936 | Medicaid | IL |
Other providers in Peru, IL
- Eugene Becker MD SC
- Eye Care Professionals of Peru OD PC
- Kayla Marie Fallen
- Family Foot Care PC
- Brenden Fasken
- Kassi Ann Filipiak
- Gailey Eye Clinic, LTD
- Rakesh K Garg
- Christine Marie Garretson
- Girlfriends, LLC
All providers in Peru, IL · Internal Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.