Healthcare Provider Details

I. General information

NPI: 1932145802
Provider Name (Legal Business Name): MARION S. VERP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE MC2050
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

5841 S MARYLAND AVE MC2050
CHICAGO IL
60637-1447
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6127
  • Fax: 773-702-0840
Mailing address:
  • Phone: 773-702-6127
  • Fax: 773-702-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: