Provider Demographics
NPI:1851451132
Name:MARIAN, CAMELIA E (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMELIA
Middle Name:E
Last Name:MARIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 HARNISH DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6846
Mailing Address - Country:US
Mailing Address - Phone:847-458-5440
Mailing Address - Fax:847-458-5450
Practice Address - Street 1:2401 HARNISH DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-6846
Practice Address - Country:US
Practice Address - Phone:847-458-5440
Practice Address - Fax:847-458-5450
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105767 2Medicaid
WIMARIACAMOtherMERCYCARE INSURANCE
ILP00466570CG6042OtherRR MEDICARE
H75698Medicare UPIN
ILR00033-510420Medicare PIN
IL036105767 2Medicaid