Provider Demographics
NPI:1386713196
Name:MART, GARY MARSHALL (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:MARSHALL
Last Name:MART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7061 NORTH AVE # 506
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1015
Mailing Address - Country:US
Mailing Address - Phone:312-509-3910
Mailing Address - Fax:844-562-0636
Practice Address - Street 1:1046 MONROE AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1426
Practice Address - Country:US
Practice Address - Phone:312-509-3910
Practice Address - Fax:312-277-6565
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361015902084P0804X, 2084P0804X
ILIL 036-101902084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101590Medicaid
IL01632730OtherBLUE CROSS BLUE SHIELD