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General NPI Number Information
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NPI Number | 1548436744
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Entity Type | Organization
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Legal Business Name | CHRIS MARUKOS DPM
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 8410 BUSTLETON AVE STE 3
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1924
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Country | US
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Telephone | 215-464-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 8410 BUSTLETON AVE STE 3
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1924
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Country | US
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Telephone | 215-464-3600
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. CHRIS MARUKOS
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Credential | DPM
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Telephone | 215-464-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | SC003264L
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License Number State | PA
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