Provider Demographics
NPI:1376571786
Name:KESSLER, MARILYN C (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:C
Last Name:KESSLER
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 1:710 N LAKE SHORE DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3006
Mailing Address - Country:US
Mailing Address - Phone:312-503-3151
Mailing Address - Fax:312-503-1377
Practice Address - Street 1:710 N LAKE SHORE DR
Practice Address - Street 2:4TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3006
Practice Address - Country:US
Practice Address - Phone:312-503-3151
Practice Address - Fax:312-503-1377
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103223207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D02925Medicare UPIN