Provider Demographics
NPI:1366555989
Name:MARSHA E. GORENS, M.D.
Entity type:Organization
Organization Name:MARSHA E. GORENS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:GORENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-421-0600
Mailing Address - Street 1:1645 W JACKSON BLVD
Mailing Address - Street 2:SUITE 318
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3276
Mailing Address - Country:US
Mailing Address - Phone:312-421-0600
Mailing Address - Fax:312-421-0660
Practice Address - Street 1:1645 W JACKSON BLVD
Practice Address - Street 2:SUITE 318
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3276
Practice Address - Country:US
Practice Address - Phone:312-421-0600
Practice Address - Fax:312-421-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL576570Medicare PIN
ILD13362Medicare UPIN