Healthcare Provider Details

I. General information

NPI: 1457464638
Provider Name (Legal Business Name): ELIZABETH ANN MARCUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 W HARRISON ST
CHICAGO IL
60612-3771
US

IV. Provider business mailing address

740 W BELDEN AVE
CHICAGO IL
60614-3302
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-5376
  • Fax: 312-864-9608
Mailing address:
  • Phone: 312-864-5385
  • Fax: 312-864-9608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number036-093110
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-093110
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: