Provider Demographics
NPI:1508822255
Name:GERDISCH, MARC W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:W
Last Name:GERDISCH
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 1:2650 WARRENVILLE RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-324-7900
Mailing Address - Fax:630-324-7942
Practice Address - Street 1:2650 WARRENVILLE RD
Practice Address - Street 2:SUITE 280
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-324-7900
Practice Address - Fax:630-324-7942
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048049A208G00000X
IL036079121208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36079121Medicaid
S26620OtherCOOK GROUP
202172OtherURBANA/ROCKFORD/MOLINE
344390OtherDUPAGE GROUP
S26620OtherCOOK GROUP
IN877470EMedicare ID - Type Unspecified
IL36079121Medicaid
F79513Medicare UPIN
877470Medicare ID - Type Unspecified
ILL92677Medicare ID - Type Unspecified