MEDICARE: MARCOS CONTRERAS

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	183700000X	Pharmacy Technician	67036628A	IN

General Provider Information

NPI Number	:	1790360311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCOS CONTRERAS

Provider Business Mailing Address
First Line	:	170 DUNEWOOD DR LOT 70
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-1984
Country	:	US
Telephone Number	:	815-579-6180
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 FRANKLIN ST
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-4504
Country	:	US
Telephone Number	:	219-874-2544
Fax Number	:

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

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/15/2021

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Directions to “ MARCOS CONTRERAS ” Practice Location

Language	Start Address	Practice Location

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