Provider Demographics
NPI:1992780266
Name:DURAN, MARINA (MD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:DURAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9977 WOODS DR FL 1
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1057
Mailing Address - Country:US
Mailing Address - Phone:224-364-2273
Mailing Address - Fax:847-663-8290
Practice Address - Street 1:9977 WOODS DR FL 1
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:224-364-2273
Practice Address - Fax:847-663-8290
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112779207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112779OtherSTATE LICENSE
IL036112779 3/4Medicaid
IL036112779-5Medicaid
IL036112779Medicaid
IL036112779-2Medicaid
01619414OtherBCBS GRP
01619414OtherBCBS GRP
IL036112779Medicaid
216966016 EP/DPMedicare PIN