Marc R. Dejong, MD
Internal Medicine, Sports Medicine in Springfield, IL. Individual provider (NPI-1).
NPI number1477549541
StatusActive
Last updated in NPPESMay 22, 2020
Details
- NPI
- 1477549541
- Entity type
- Individual (NPI-1)
- Name
- Marc R. Dejong
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 23, 2005
- Certification date
- May 22, 2020
- Last updated
- May 22, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - SPORTS MEDICINE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RS0010X | Internal Medicine, Sports Medicine | 036114259 | IL | Yes |
| 207R00000X | Internal Medicine | 036114259 | IL |
Practice location
800 N 1st StSpringfield, IL 62702-3719
Phone 217-528-7541 · Fax 217-527-1103
Mailing address
1025 S 6th StSpringfield, IL 62703-2403
Phone 217-528-7541 · Fax 217-528-8962
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