Marc Burks, P.A.-C
Individual provider Active NPI Physician Assistant · Matteson, IL
NPI 1336491992 · NPPES record last updated Oct 8, 2012
Key facts
- NPI
- 1336491992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 085.004327 (IL)
- Practice address
- 4747 Lincoln Mall Dr Ste 304
Matteson, IL 60443-3814 - Phone
- (708) 898-2608
- Fax
- (708) 248-5950
- NPI assigned
- Oct 8, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085.004327 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Docs at the Door Inc | Past |
Accepting new patients | |
| United Medical Group, SC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085.004327 | IL | Yes |
Addresses
Primary practice location
4747 Lincoln Mall Dr Ste 304
Matteson, IL 60443-3814
Mailing address
1665 W 104TH St
Chicago, IL 60643-2822
Phone (773) 238-4430
Other providers in Matteson, IL
- Budget Energy Marketing LLC
- Budget Energy Marketing LLC
- Desiree Buford
- Stefanie Burby
- Joseph Quentin Burchett
- Barbara Burns
- Barbara Maria Butler Meagher
- Angela Cade
- Camelot Care Centers, LLC
- Vernest Cantrell II
All providers in Matteson, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.