Provider Demographics
NPI:1174679252
Name:MARSHALL I MATZ & DAVID M SHENKER MDSC
Entity Type:Organization
Organization Name:MARSHALL I MATZ & DAVID M SHENKER MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:I
Authorized Official - Last Name:MATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-332-2226
Mailing Address - Street 1:1431 N WESTERN AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1797
Mailing Address - Country:US
Mailing Address - Phone:312-332-2226
Mailing Address - Fax:773-276-1197
Practice Address - Street 1:1431 N WESTERN AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1797
Practice Address - Country:US
Practice Address - Phone:312-332-2226
Practice Address - Fax:773-276-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360398122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615166OtherBLUE SHIELD
IL=========OtherTAX ID