Provider Demographics
NPI:1225037989
Name:KAMEN, MARCY (MD)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:KAMEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 SHERMER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5317
Mailing Address - Country:US
Mailing Address - Phone:847-272-4600
Mailing Address - Fax:847-272-4655
Practice Address - Street 1:1885 SHERMER RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5317
Practice Address - Country:US
Practice Address - Phone:847-272-4600
Practice Address - Fax:847-272-4655
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082892OtherSTATE LICENSE
IL540920Medicare ID - Type Unspecified
IL976700Medicare ID - Type UnspecifiedGROUP MEDICARE #