Healthcare Provider Details

I. General information

NPI: 1598059982
Provider Name (Legal Business Name): MAYURI MORKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 BETHANY RD SUITE #3
DEKALB IL
60115-4908
US

IV. Provider business mailing address

840 N ROY AVE
NORTHLAKE IL
60164-1213
US

V. Phone/Fax

Practice location:
  • Phone: 815-758-5800
  • Fax: 815-758-5144
Mailing address:
  • Phone: 708-409-9786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.126280
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: