Individual
MARCUS LARON FORWARD II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4900 N CUMBERLAND AVE, NORRIDGE, IL 60706-2901
(708) 456-1600
Mailing address
2003 W FULTON ST # 303, CHICAGO, IL 60612-2345
(312) 243-2223
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008479
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/08/2020
Last updated
03/04/2022
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