Healthcare Provider Details

I. General information

NPI: 1053461095
Provider Name (Legal Business Name): JOHN F MARCINAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 HARVESTER DR STE 110
BURR RIDGE IL
60527-6686
US

IV. Provider business mailing address

5841 S MARYLAND AVE # MC1099
CHICAGO IL
60637-1447
US

V. Phone/Fax

Practice location:
  • Phone: 773-834-4064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: