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General NPI Number Information
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NPI Number | 1720064165
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Entity Type | Individual
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Provider Name | MICHAEL J MARCUS DPM
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Gender | Male
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 101 E BEVERLY BLVD SUITE 205
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City | MONTEBELLO
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State | CA
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Zip | 90640-4315
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Country | US
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Telephone | 323-724-6663
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Fax | 323-724-5816
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Provider Business Mailing Address
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Address Line | 101 E BEVERLY BLVD STE 205
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City | MONTEBELLO
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State | CA
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Zip | 90640-4315
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Country | US
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Telephone | 323-724-6663
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Fax | 323-724-5816
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E1928
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License Number State | CA
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