MEDICARE: JOHN MARK FLACK MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036-138254	IL
2	207RH0005X	Hypertension Specialist Physician	036-138254	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164450987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MARK FLACK MD, MPH

Provider Business Mailing Address
First Line	:	PO BOX 19636
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9636
Country	:	US
Telephone Number	:	217-545-8000
Fax Number	:	217-545-4735

Provider Business Practice Location Address
First Line	:	751 N RUTLEDGE ST
Second Line	:	SUITE 1100
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-4968
Country	:	US
Telephone Number	:	217-545-8000
Fax Number	:	217-545-4735

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	10/21/2020

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