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General NPI Number Information
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NPI Number | 1366555989
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Entity Type | Organization
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Legal Business Name | MARSHA E. GORENS, M.D.
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 1645 W JACKSON BLVD SUITE 318
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City | CHICAGO
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State | IL
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Zip | 60612-3276
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Country | US
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Telephone | 312-421-0600
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Fax | 312-421-0660
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Provider Business Mailing Address
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Address Line | 1645 W JACKSON BLVD SUITE 318
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City | CHICAGO
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State | IL
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Zip | 60612-3276
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Country | US
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Telephone | 312-421-0600
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Fax | 312-421-0660
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARSHA ELAINE GORENS
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Credential |
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Telephone | 312-421-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | IL
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