MEDICARE: DR. EDWARD LAWRENCE MARUT 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	207VE0102X	Reproductive Endocrinology Physician		IL

General Provider Information

NPI Number	:	1134104193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD LAWRENCE MARUT M.D.

Provider Business Mailing Address
First Line	:	3703 W LAKE AVE
Second Line	:	SUITE 310- ATTN FCI
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5823
Country	:	US
Telephone Number	:	847-729-2188
Fax Number	:	847-729-7496

Provider Business Practice Location Address
First Line	:	3703 W LAKE AVE
Second Line	:	STE 310-ATTN FCI
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5823
Country	:	US
Telephone Number	:	847-729-2188
Fax Number	:	847-729-7496

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	09/04/2007

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