Healthcare Provider Details

I. General information

NPI: 1891944666
Provider Name (Legal Business Name): MARSON TENOSO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TOWER CT SUITE 150
GURNEE IL
60031-3336
US

IV. Provider business mailing address

15 TOWER CT SUITE 150
GURNEE IL
60031-3336
US

V. Phone/Fax

Practice location:
  • Phone: 847-623-4464
  • Fax:
Mailing address:
  • Phone: 847-623-4464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036121976
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: