Provider Demographics
NPI:1386668770
Name:KIRBY, MARLON S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLON
Middle Name:S
Last Name:KIRBY
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 1:5430 S EAST VIEW PARK APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5932
Mailing Address - Country:US
Mailing Address - Phone:773-955-0993
Mailing Address - Fax:
Practice Address - Street 1:500 E. 51ST STREET
Practice Address - Street 2:PROVIDENT HOSPITAL OF COOK COUNTY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615
Practice Address - Country:US
Practice Address - Phone:312-572-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-086268207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology