Provider Demographics
NPI:1952494361
Name:MERIN, ELSA MARQUEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:MARQUEZ
Last Name:MERIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7435 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1542
Mailing Address - Country:US
Mailing Address - Phone:708-771-0250
Mailing Address - Fax:708-771-0686
Practice Address - Street 1:7435 W. MADISON ST.
Practice Address - Street 2:
Practice Address - City:FOREST PARK,
Practice Address - State:IL
Practice Address - Zip Code:60130-1542
Practice Address - Country:US
Practice Address - Phone:708-771-0250
Practice Address - Fax:708-771-0686
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21605310OtherBLUE CROSS ID#
ILD12844Medicare UPIN