Provider Demographics
NPI:1851587125
Name:MARCUS, MARTIN J
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:MARCUS
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 1:222 N LASALLE ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-1003
Mailing Address - Country:US
Mailing Address - Phone:312-704-5511
Mailing Address - Fax:312-346-3991
Practice Address - Street 1:222 N LASALLE ST
Practice Address - Street 2:SUITE 230
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-1003
Practice Address - Country:US
Practice Address - Phone:312-704-5511
Practice Address - Fax:312-346-3991
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice