MEDICARE: DR. ROBERT WILLIAM MARQUIS M.D.

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	2084P0800X	Psychiatry Physician	0360055192	IL

General Provider Information

NPI Number	:	1376668574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WILLIAM MARQUIS M.D.

Provider Business Mailing Address
First Line	:	20825 LONDON DR
Second Line	:
City	:	OLYMPIA FIELDS
State	:	IL
Zip	:	60461-1874
Country	:	US
Telephone Number	:	708-479-0700
Fax Number	:	708-479-8959

Provider Business Practice Location Address
First Line	:	19635 LA GRANGE RD
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-9360
Country	:	US
Telephone Number	:	708-479-0700
Fax Number	:	708-479-8959

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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