Healthcare Provider Details

I. General information

NPI: 1518998327
Provider Name (Legal Business Name): MARK TIMOTHY MONAHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E 1ST ST
DIXON IL
61021-3116
US

IV. Provider business mailing address

403 E 1ST ST
DIXON IL
61021-3116
US

V. Phone/Fax

Practice location:
  • Phone: 815-288-5531
  • Fax: 815-285-5558
Mailing address:
  • Phone: 815-288-5531
  • Fax: 815-285-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01057437A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036107925
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: