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NPI Code Detail

MEDICARE: DR. ESHO S MARCUS DMD

MEDICARE:  DR. ESHO S MARCUS  DMD
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
1122300000XDentist019.016625IL

General Provider Information

NPI Number : 1396809455
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ESHO S MARCUS DMD
Provider Business Mailing Address
First Line : 2722 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3920
Country : US
Telephone Number : 773-262-0500
Fax Number : 773-262-2245
Provider Business Practice Location Address
First Line : 2722 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3920
Country : US
Telephone Number : 773-262-0500
Fax Number : 773-262-2245
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 07/08/2007

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Directions to “ DR. ESHO S MARCUS DMD” Practice Location

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