MEDICARE: ALFREDO MARULANDA

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1609456185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFREDO MARULANDA

Provider Business Mailing Address
First Line	:	5928 N PAULINA ST APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-3234
Country	:	US
Telephone Number	:	401-663-4437
Fax Number	:

Provider Business Practice Location Address
First Line	:	4872 N KENMORE AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3726
Country	:	US
Telephone Number	:	312-508-8676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2021
Last Update Date	:	04/09/2021

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Directions to “ ALFREDO MARULANDA ” Practice Location

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