Provider Demographics
NPI:1518927185
Name:TENZER, MARC L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
Last Name:TENZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-774-5020
Mailing Address - Fax:773-774-4967
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-774-5020
Practice Address - Fax:773-774-4967
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069030207RC0000X
CAG68772207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069030Medicaid
IL036069030Medicaid
L02603Medicare PIN