Provider Demographics
NPI:1073620936
Name:SINSAKUL, MARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:SINSAKUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1821
Mailing Address - Country:US
Mailing Address - Phone:312-829-1424
Mailing Address - Fax:312-850-8431
Practice Address - Street 1:1426 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1821
Practice Address - Country:US
Practice Address - Phone:312-829-1424
Practice Address - Fax:312-850-8431
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099895207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615381OtherBC/BS ID NUMBER
GA390008272OtherRAILROAD MEDICARE
IL036099895Medicaid
ILL86504Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
IL01615381OtherBC/BS ID NUMBER