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General NPI Number Information
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NPI Number | 1598059982
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Entity Type | Individual
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Provider Name | MAYURI MORKER MD
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Gender | Female
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 625 BETHANY RD SUITE #3
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City | DEKALB
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State | IL
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Zip | 60115-4908
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Country | US
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Telephone | 815-758-5800
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Fax | 815-758-5144
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Provider Business Mailing Address
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Address Line | 840 N ROY AVE
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City | NORTHLAKE
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State | IL
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Zip | 60164-1213
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Country | US
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Telephone | 708-409-9786
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.126280
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License Number State | IL
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