Provider Demographics
NPI:1467866228
Name:MARNERIS, ATHANASIOS GEORGE (DO)
Entity Type:Individual
Prefix:DR
First Name:ATHANASIOS
Middle Name:GEORGE
Last Name:MARNERIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20303 CRAWFORD AVE
Mailing Address - Street 2:STE LL1
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1173
Mailing Address - Country:US
Mailing Address - Phone:616-252-7800
Mailing Address - Fax:
Practice Address - Street 1:20303 CRAWFORD AVE STE LL
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1073
Practice Address - Country:US
Practice Address - Phone:708-898-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.150478207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.150478Medicaid