Healthcare Provider Details

I. General information

NPI: 1437163540
Provider Name (Legal Business Name): JOHN COON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 MAIN ST SUITE B
PEORIA IL
61602-1076
US

IV. Provider business mailing address

5100 RELIABLE PKWY
CHICAGO IL
60686-0001
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-4908
  • Fax:
Mailing address:
  • Phone: 309-672-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number036048214
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036048214
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: