Individual provider · NPI-1

Mark P Iltis, MD

Family Medicine · Durant, IA

NPI number1659369353
StatusActive
Last updated in NPPESMay 27, 2021

Details

NPI
1659369353
Entity type
Individual (NPI-1)
Name
Mark P Iltis
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Oct 7, 2005
Certification date
May 27, 2021
Last updated
May 27, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine27823IAYes

Practice location

619 5th Street
Durant, IA 52747

Phone 563-785-4487 · Fax 563-785-6681

Mailing address

865 Lincoln Rd
Ste L10
Bettendorf, IA 52722-4190

Phone 563-355-9191 · Fax 563-355-3419

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