MEDICARE: ROBERT K MARSHALL, LLC

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	261QM0850X	Adult Mental Health Clinic/Center	71-2524	IL

General Provider Information

NPI Number	:	1033583851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT K MARSHALL, LLC

Provider Business Mailing Address
First Line	:	521 CLINTON AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60304-1110
Country	:	US
Telephone Number	:	847-533-3806
Fax Number	:

Provider Business Practice Location Address
First Line	:	9631 W 153RD ST STE 38
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-3778
Country	:	US
Telephone Number	:	847-533-3806
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT K MARSHALL
Credential	:	PH.D.
Telephone Number	:	847-533-3806

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	11/17/2015

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