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General NPI Number Information
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NPI Number | 1770680431
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Entity Type | Individual
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Provider Name | ANDRES LUIS MARIUS-NUNEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 7036 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2197
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Country | US
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Telephone | 708-484-9145
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Fax | 708-484-0441
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Provider Business Mailing Address
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Address Line | 7036 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2197
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Country | US
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Telephone | 708-484-9145
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Fax | 708-484-0441
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 036077902
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License Number State | IL
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