Provider Demographics
NPI:1891703591
Name:MARBACH, WALTER JOHN (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JOHN
Last Name:MARBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 MCCLINTOCK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0872
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:630-654-4253
Practice Address - Street 1:13755 CICERO AVE
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60445-1824
Practice Address - Country:US
Practice Address - Phone:888-220-6432
Practice Address - Fax:708-385-7840
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-057150207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36057150Medicaid
IL36057150Medicaid
IL581040Medicare PIN
ILK46927Medicare PIN
ILC39485Medicare UPIN