MEDICARE: KRISTEN ELIZABETH MARCUM DO

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	207R00000X	Internal Medicine Physician	34.018743	OH

General Provider Information

NPI Number	:	1578266839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN ELIZABETH MARCUM DO

Provider Business Mailing Address
First Line	:	3780 MEDINA RD STE 310
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-9312
Country	:	US
Telephone Number	:	330-725-8441
Fax Number	:

Provider Business Practice Location Address
First Line	:	3780 MEDINA RD STE 310
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-9312
Country	:	US
Telephone Number	:	330-725-8441
Fax Number	:

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

Provider Enumeration Date	:	03/24/2023
Last Update Date	:	06/25/2026

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