MEDICARE: ESHO S MARCUS DMD PC

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	261QD0000X	Dental Clinic/Center	060-003714	IL

General Provider Information

NPI Number	:	1154596021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESHO S MARCUS DMD PC

Provider Business Mailing Address
First Line	:	2722 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3920
Country	:	US
Telephone Number	:	773-262-0500
Fax Number	:	773-262-2256

Provider Business Practice Location Address
First Line	:	2722 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3920
Country	:	US
Telephone Number	:	773-262-0500
Fax Number	:	773-262-2256

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ESHO S MARCUS
Credential	:	DMD
Telephone Number	:	773-262-0500

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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