Provider Demographics
NPI:1508947383
Name:ADAJAR, MARC ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALLAN
Last Name:ADAJAR
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 1:1835 W FARRAGUT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1009
Mailing Address - Country:US
Mailing Address - Phone:847-858-6432
Mailing Address - Fax:
Practice Address - Street 1:2845 N SHERIDAN ROAD, SUITE 714
Practice Address - Street 2:SUITE 714
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6065
Practice Address - Country:US
Practice Address - Phone:773-561-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361149232086S0102X, 2086S0127X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK38772Medicaid
ILK38772Medicaid