Healthcare Provider Details

I. General information

NPI: 1083496525
Provider Name (Legal Business Name): DR. MARWAN ALKASSIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 S MICHIGAN AVE APT 3414
CHICAGO IL
60605-2323
US

IV. Provider business mailing address

4 ALLEE DES FEUILLANTINES BATIMENT B CHEZ JAD ALKASSIS
VILLEJUIF ILE DE FRANCE
94800
FR

V. Phone/Fax

Practice location:
  • Phone: 872-335-8585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number125083060
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number125083060
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: