Healthcare Provider Details

I. General information

NPI: 1447490305
Provider Name (Legal Business Name): MARC EMILE HALLEZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 W CONGRESS PARKWAY RUSH HEALTH ASSOCIATES
CHICAGO IL
60612
US

IV. Provider business mailing address

714 S WASHINGTON ST
ELMHURST IL
60126-4349
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-4082
  • Fax: 312-563-4402
Mailing address:
  • Phone: 847-651-5675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number041.347466
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: