Marcus Ismedhi Mutidjo, APN is a family nurse practitioner in Peoria, IL. Marcus Ismedhi Mutidjo, APN NPI is 1063825446. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
1701 W GARDEN ST
PEORIA, IL
ZIP 61605
Phone: (309) 680-7600
Fax: (309) 680-7686
The NPI 1063825446 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.
The enumeration date for this NPI number is 6/3/2014 and was last updated on 1/14/2019.