Healthcare Provider Details

I. General information

NPI: 1609187707
Provider Name (Legal Business Name): MARIELLE FRICCHIONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W OGDEN AVE
CHICAGO IL
60612-4219
US

IV. Provider business mailing address

2160 W OGDEN AVE
CHICAGO IL
60612-4219
US

V. Phone/Fax

Practice location:
  • Phone: 312-746-5382
  • Fax:
Mailing address:
  • Phone: 312-746-5382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036130640
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125058778
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number036-130640
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: