Provider Demographics
NPI:1891944666
Name:TENOSO, MARSON (MD)
Entity Type:Individual
Prefix:
First Name:MARSON
Middle Name:
Last Name:TENOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TOWER CT
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3336
Mailing Address - Country:US
Mailing Address - Phone:847-623-4464
Mailing Address - Fax:
Practice Address - Street 1:15 TOWER CT
Practice Address - Street 2:SUITE 150
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3336
Practice Address - Country:US
Practice Address - Phone:847-623-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121976208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics