MEDICARE: MARJERIE M BADILLA M.D. S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	036051999-1	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528009826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARJERIE M BADILLA M.D. S.C.

Provider Business Mailing Address
First Line	:	2510 W IRVING PARK RD
Second Line	:	UNIT D
City	:	CHICAGO
State	:	IL
Zip	:	60618-3716
Country	:	US
Telephone Number	:	773-583-6955
Fax Number	:	773-604-2201

Provider Business Practice Location Address
First Line	:	2510 W IRVING PARK RD
Second Line	:	UNIT D
City	:	CHICAGO
State	:	IL
Zip	:	60618-3716
Country	:	US
Telephone Number	:	773-583-6955
Fax Number	:	773-604-2201

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MS. ROXANNE J. ALCANTARA
Credential	:
Telephone Number	:	773-583-6955

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	08/22/2020

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