Healthcare Provider Details

I. General information

NPI: 1548821598
Provider Name (Legal Business Name): MANUEL ANTONIO HACHE MARLIERE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 10
CHICAGO IL
60612-3849
US

IV. Provider business mailing address

1725 W HARRISON ST STE 10
CHICAGO IL
60612-3849
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6744
  • Fax:
Mailing address:
  • Phone: 312-942-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036164871
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036164871
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number319094
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036164871
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: