Provider Demographics
NPI:1588621601
Name:MARIN, THELMA S (MD)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:S
Last Name:MARIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7530 WOODWARD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3100
Mailing Address - Country:US
Mailing Address - Phone:630-910-1177
Mailing Address - Fax:630-910-4157
Practice Address - Street 1:7530 WOODWARD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3100
Practice Address - Country:US
Practice Address - Phone:630-910-1177
Practice Address - Fax:630-910-4157
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036089513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2201574OtherBLUECROSS BLUESHIELD
ILG22789Medicare UPIN