Marshall Elliott Kordon, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.005308 Issued in IL

Practice address

5100 N Ravenswood Ave Ste 239
Chicago, IL 60640-1752

Phone

(773) 267-3703

Fax

(773) 267-3703

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1487689972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 N RAVENSWOOD AVE STE 239",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401752",
            "telephone_number": "773-267-3703",
            "fax_number": "773-267-3703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 N RAVENSWOOD AVE STE 239",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401752",
            "telephone_number": "773-267-3703",
            "fax_number": "773-267-3703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORDON",
        "first_name": "MARSHALL",
        "middle_name": "ELLIOTT",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.005308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "364256529",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "01621915",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Kordi, DMD
• Abbe Kordik
• Zachary Andrew Kordik, M.D.
• Avram Cibul Kordon, MD
• Laura Cibul Kordon, M.D.
• Victoria Kordon, O.D.
• Mitchell Kordzikowski
• Idil Kore, M.D.
• Oryana Koreal
• Anjum F Koreishi, MD

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.