Individual
DR. MARCUS S DERANIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2442 N ROUTE 121, DECATUR, IL 62526-9461
(217) 233-3101
(217) 233-3107
Mailing address
2442 N ROUTE 121, DECATUR, IL 62526-9461
(217) 233-3101
(217) 233-3107
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
036069820
IL
152WC0802X
Corneal and Contact Management Optometrist
036069820
IL
207W00000X
Ophthalmology Physician
Primary
036-069820
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036069820
—
IL
01
—
180033361
RAILROAD MEDICARE
IL
01
—
374073
HEALTHLINK
IL
01
—
49175
PERSONAL CARE
IL
Enumeration date
04/25/2006
Last updated
11/20/2009
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