Individual
MARC PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
355 RIDGE AVE, EVANSTON, IL 60202-3399
(847) 316-4000
Mailing address
3333 GREEN BAY RD, NORTH CHICAGO, IL 60064-3037
(603) 938-5108
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125076971
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2019
Last updated
08/31/2020
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