Healthcare Provider Details

I. General information

NPI: 1649624644
Provider Name (Legal Business Name): ZACHARY ALESSANDRO MARCUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2016
Last Update Date: 09/24/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E 59TH ST MC 3052
CHICAGO IL
60637
US

IV. Provider business mailing address

840 E 59TH ST MC 3052
CHICAGO IL
60637
US

V. Phone/Fax

Practice location:
  • Phone: 773-834-9355
  • Fax:
Mailing address:
  • Phone: 773-834-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036147138
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: