Healthcare Provider Details

I. General information

NPI: 1235251703
Provider Name (Legal Business Name): IRENE MARKS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST 4TH FLOOR
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

3303 S. MICHIGAN AVE. UNIT #3
CHICAGO IL
60616
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-0854
  • Fax: 312-864-9580
Mailing address:
  • Phone: 312-791-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209004377
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: