Healthcare Provider Details

I. General information

NPI: 1548230055
Provider Name (Legal Business Name): MARLENE MORRISON TURVILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 PRINCETON AVE
EVANSTON IL
60201-4940
US

IV. Provider business mailing address

2535 PRINCETON AVE
EVANSTON IL
60201-4940
US

V. Phone/Fax

Practice location:
  • Phone: 847-644-8540
  • Fax: 847-886-0112
Mailing address:
  • Phone: 847-644-8540
  • Fax: 847-886-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-097004
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-097004
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: