Healthcare Provider Details

I. General information

NPI: 1356342398
Provider Name (Legal Business Name): MARC J OVADIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST STE 605
PARK RIDGE IL
60068-1168
US

IV. Provider business mailing address

1875 DEMPSTER STREET PARKSIDE BUILDING SUITE 605
PARKRIDGE IL
60068
US

V. Phone/Fax

Practice location:
  • Phone: 773-612-4184
  • Fax: 847-692-6755
Mailing address:
  • Phone: 773-612-4184
  • Fax: 847-692-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number170004
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036103080
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036103080
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number036103080
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: