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General NPI Number Information
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NPI Number | 1386713196
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Entity Type | Individual
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Provider Name | GARY MARSHALL MART M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 1046 MONROE AVE
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City | RIVER FOREST
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State | IL
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Zip | 60305-1426
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Country | US
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Telephone | 312-509-3910
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Fax | 312-277-6565
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Provider Business Mailing Address
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Address Line | 7061 NORTH AVE # 506
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City | OAK PARK
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State | IL
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Zip | 60302-1015
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Country | US
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Telephone | 312-509-3910
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Fax | 844-562-0636
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036101590
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License Number State | IL
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