Provider Demographics
NPI:1629622113
Name:RIAS, MARLON
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:RIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 HAZEL LN
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1614
Mailing Address - Country:US
Mailing Address - Phone:708-335-2464
Mailing Address - Fax:
Practice Address - Street 1:3510 HAZEL LN
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1614
Practice Address - Country:US
Practice Address - Phone:708-335-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)