Basic Information
| Provider Information | |||||||||
| NPI: | 1275521122 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARCUS | ||||||||
| FirstName: | SETH | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1875 DEMPSTER ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | PARK RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600681186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477237705 | ||||||||
| FaxNumber: | 8477238675 | ||||||||
| Practice Location | |||||||||
| Address1: | 1875 DEMPSTER ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | PARK RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600681186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477237705 | ||||||||
| FaxNumber: | 8477238675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.