Provider Demographics
NPI:1568780187
Name:MARILYN MARCUS DO PA
Entity Type:Organization
Organization Name:MARILYN MARCUS DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:PROZZILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-253-0040
Mailing Address - Street 1:18430 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6816
Mailing Address - Country:US
Mailing Address - Phone:305-253-0040
Mailing Address - Fax:305-253-0177
Practice Address - Street 1:18430 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6816
Practice Address - Country:US
Practice Address - Phone:305-253-0040
Practice Address - Fax:305-253-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81920Medicare PIN