Healthcare Provider Details

I. General information

NPI: 1194897124
Provider Name (Legal Business Name): GREGORY G MARKARIAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 01/18/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W DELAWARE PL
CHICAGO IL
60610
US

IV. Provider business mailing address

33 W DELAWARE PL
CHICAGO IL
60610
US

V. Phone/Fax

Practice location:
  • Phone: 312-255-7540
  • Fax: 312-255-1276
Mailing address:
  • Phone: 312-255-7540
  • Fax: 312-255-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number036091945
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: