MEDICARE: ANDRES LUIS MARIUS-NUNEZ 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	174400000X	Specialist	036077902	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1607253	OTHER	IL	BCBS OF ILLINOIS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770680431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRES LUIS MARIUS-NUNEZ M.D.

Provider Business Mailing Address
First Line	:	7036 CERMAK RD
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-2197
Country	:	US
Telephone Number	:	708-484-9145
Fax Number	:	708-484-0441

Provider Business Practice Location Address
First Line	:	7036 CERMAK RD
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-2197
Country	:	US
Telephone Number	:	708-484-9145
Fax Number	:	708-484-0441

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	02/02/2024

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