Provider Demographics
NPI:1952552416
Name:KEITH A. MARCUS, MD INC.
Entity type:Organization
Organization Name:KEITH A. MARCUS, MD INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-544-5010
Mailing Address - Street 1:1815 VIA EL PRADO
Mailing Address - Street 2:SUITE 102
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5722
Mailing Address - Country:US
Mailing Address - Phone:310-544-5010
Mailing Address - Fax:
Practice Address - Street 1:1815 VIA EL PRADO
Practice Address - Street 2:SUITE 102
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5722
Practice Address - Country:US
Practice Address - Phone:310-544-5010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102230261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty