Provider Demographics
NPI:1134151368
Name:MARKS, EDWIN M (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:M
Last Name:MARKS
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 1:3128 QUINCY LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6815
Mailing Address - Country:US
Mailing Address - Phone:630-862-6359
Mailing Address - Fax:
Practice Address - Street 1:4021 S 700 E
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2192
Practice Address - Country:US
Practice Address - Phone:800-423-1605
Practice Address - Fax:801-284-6775
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology