Provider Demographics
NPI:1689619777
Name:MARUKOS, CHRIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:MARUKOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8410 BUSTLETON AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1924
Mailing Address - Country:US
Mailing Address - Phone:215-464-3600
Mailing Address - Fax:215-220-3437
Practice Address - Street 1:8410 BUSTLETON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-1924
Practice Address - Country:US
Practice Address - Phone:215-464-3600
Practice Address - Fax:215-220-3437
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003264L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA041134493Medicaid
PA041134493Medicaid
PAT30377Medicare UPIN