Healthcare Provider Details

I. General information

NPI: 1275919375
Provider Name (Legal Business Name): MARC-OLIVIER KISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 N. MARINE DRIVE BONE AND JOINT REPLACEMENT CENTER
CHICAGO IL
60640
US

IV. Provider business mailing address

4646 N. MARINE DRIVE BONE AND JOINT REPLACEMENT CENTER
CHICAGO IL
60640
US

V. Phone/Fax

Practice location:
  • Phone: 773-564-5881
  • Fax: 773-564-5886
Mailing address:
  • Phone: 773-564-5881
  • Fax: 773-564-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: