Healthcare Provider Details

I. General information

NPI: 1912908583
Provider Name (Legal Business Name): MARC A DORFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W HIGHWAY 22
BARRINGTON IL
60010
US

IV. Provider business mailing address

PO BOX 98
BARRINGTON IL
60011-0098
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-9600
  • Fax: 616-285-0846
Mailing address:
  • Phone: 847-381-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036086890
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number036.086890
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: