Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036090059 | IL |
NPI | 1023082328 |
---|---|
Provider Name | Guido Marra |
First Address | Chicago, IL 60611-3926 |
Second Address | Chicago, IL 60611-3926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36090059 | (05) | IL |
G82913 | (02) |