Provider Demographics
NPI:1316127673
Name:NEWMAN, MARVIN (DO)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E HURON ST
Mailing Address - Street 2:# 2004
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2932
Mailing Address - Country:US
Mailing Address - Phone:954-295-5012
Mailing Address - Fax:312-643-1207
Practice Address - Street 1:100 E HURON ST
Practice Address - Street 2:2004
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2932
Practice Address - Country:US
Practice Address - Phone:954-295-5012
Practice Address - Fax:312-643-1207
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 2718207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology