Provider Demographics
NPI:1801102058
Name:GARCIA, MARLON DIAZ (MD)
Entity type:Individual
Prefix:DR
First Name:MARLON
Middle Name:DIAZ
Last Name:GARCIA
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 1:1926 W HARRISON ST
Mailing Address - Street 2:APT 1000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3737
Mailing Address - Country:US
Mailing Address - Phone:312-852-1336
Mailing Address - Fax:
Practice Address - Street 1:1926 W HARRISON ST
Practice Address - Street 2:APT 1000
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3737
Practice Address - Country:US
Practice Address - Phone:312-852-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-132501207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist