Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036147744 | IL |
NPI | 1043637325 |
---|---|
Provider Name | Dr. Marc Harrison Nelson |
First Address | Libertyville, IL 60048-5265 |
Second Address | Libertyville, IL 60048-5265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2014 |
Last Update Date | 08/12/2021 |