Healthcare Provider Details

I. General information

NPI: 1851377162
Provider Name (Legal Business Name): GEORGE MARCUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 SOUTHVIEW ST
OWATONNA MN
55060-3241
US

IV. Provider business mailing address

2200 NW 26TH ST
OWATONNA MN
55060-5503
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-1120
  • Fax: 507-444-6287
Mailing address:
  • Phone: 507-451-1120
  • Fax: 507-444-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number43203
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: