Healthcare Provider Details

I. General information

NPI: 1598996134
Provider Name (Legal Business Name): MICHAEL J. MARCUS DPM A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 SAND CANYON AVENUE SUITE 708
IRVINE CA
92618-3707
US

IV. Provider business mailing address

101 E BEVERLY BLVD STE 205
MONTEBELLO CA
90640-4315
US

V. Phone/Fax

Practice location:
  • Phone: 949-727-3884
  • Fax: 949-753-9115
Mailing address:
  • Phone: 323-724-6663
  • Fax: 323-724-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J. MARCUS
Title or Position: PHYSICIAN
Credential: D.P.M.
Phone: 323-724-6663