MEDICARE: MARC R. SPILLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	036107397	IL

General Provider Information

NPI Number	:	1093715815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC R. SPILLER M.D.

Provider Business Mailing Address
First Line	:	200 N BRYANT AVE STE 10
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-6273
Country	:	US
Telephone Number	:	888-447-2450
Fax Number	:	630-874-2642

Provider Business Practice Location Address
First Line	:	3815 HIGHLAND AVE
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1500
Country	:	US
Telephone Number	:	877-485-4474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	12/23/2021

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