Healthcare Provider Details

I. General information

NPI: 1912312547
Provider Name (Legal Business Name): MARILYN FEATHERSTON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 710
CHICAGO IL
60612-3863
US

IV. Provider business mailing address

1725 W HARRISON ST STE 710
CHICAGO IL
60612-3863
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5000
  • Fax:
Mailing address:
  • Phone: 312-942-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125-065670
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberOT017636
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number036.152651
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: