Individual
MR. KEITH A. MARINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1901 W HARRISON ST, CHICAGO, IL 60612-3714
(312) 400-2978
Mailing address
1272 DROVER DR, LEMONT, IL 60439-7348
(708) 299-9858
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209-003972
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104841451
—
IL
Enumeration date
07/13/2006
Last updated
04/27/2021
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