Basic Information
| Provider Information | |||||||||
| NPI: | 1740239359 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAR ASSOCIATES, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 388320 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606388320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737678283 | ||||||||
| FaxNumber: | 7737678320 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 W DIVISION ST | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606222717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733420993 | ||||||||
| FaxNumber: | 7733420996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 08/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | MUNOZ | ||||||||
| AuthorizedOfficialFirstName: | MARCELO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7733420993 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 036046253 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 036046253 | 05 | IL | MEDICAID | P00158604 | 01 | IL | MEDICARE TRAVELERS | OTHER | 0021602771 | 01 | IL | BLUE SHIELD | OTHER |