Healthcare Provider Details

I. General information

NPI: 1316031396
Provider Name (Legal Business Name): ROBERT MARSHALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6660 W RAVEN ST
CHICAGO IL
60631-2506
US

IV. Provider business mailing address

6600 WEST RAVEN STREET
CHICAGO IL
60631-2506
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-5702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-106479
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number36698
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-106479
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036-106479
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: