Provider Demographics
NPI:1902823347
Name:GORENS, MARSHA ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:ELAINE
Last Name:GORENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S ASHLAND AVE
Mailing Address - Street 2:STE 502
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2712
Mailing Address - Country:US
Mailing Address - Phone:312-421-0600
Mailing Address - Fax:312-421-0660
Practice Address - Street 1:300 S ASHLAND AVE
Practice Address - Street 2:STE 502
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2712
Practice Address - Country:US
Practice Address - Phone:312-421-0600
Practice Address - Fax:312-421-0660
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068789207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068789Medicaid
ILD13362Medicare UPIN
IL036068789Medicaid