Individual
DUSTIN MARLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
676 N SAINT CLAIR ST STE 940, CHICAGO, IL 60611-2945
(312) 926-8358
(312) 926-9630
Mailing address
676 N SAINT CLAIR ST STE 940, CHICAGO, IL 60611-2945
(312) 926-8358
(312) 926-9630
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085010476
IL
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
941934
—
AZ
01
—
Z169943
MEDICARE PTAN
AZ
Enumeration date
07/31/2014
Last updated
11/19/2024
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