Healthcare Provider Details

I. General information

NPI: 1033122684
Provider Name (Legal Business Name): MAREALITA MARIA PIERCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E 53RD ST SUITE 832
CHICAGO IL
60615-4557
US

IV. Provider business mailing address

5400 S HYDE PARK BLVD UNIT A2
CHICAGO IL
60615-5828
US

V. Phone/Fax

Practice location:
  • Phone: 773-643-2550
  • Fax: 773-643-3603
Mailing address:
  • Phone: 773-955-2852
  • Fax: 773-955-2852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-096342
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: