Healthcare Provider Details

I. General information

NPI: 1710008040
Provider Name (Legal Business Name): MARIN SEKOSAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST LL862
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

7916 E PRAIRIE RD
SKOKIE IL
60076-3415
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-7546
  • Fax: 312-864-9692
Mailing address:
  • Phone: 847-675-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036-075823
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: