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NPI Code Detail

MEDICARE: MARC PORTER

MEDICARE: MARC PORTER
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
1207R00000XInternal Medicine Physician125076971IL
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1992368534
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARC PORTER
Provider Business Mailing Address
First Line : 3333 GREEN BAY RD
Second Line :
City : NORTH CHICAGO
State : IL
Zip : 60064-3037
Country : US
Telephone Number : 603-938-5108
Fax Number :
Provider Business Practice Location Address
First Line : 355 RIDGE AVE
Second Line :
City : EVANSTON
State : IL
Zip : 60202-3399
Country : US
Telephone Number : 847-316-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2019
Last Update Date : 08/31/2020

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Directions to “ MARC PORTER ” Practice Location

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