Healthcare Provider Details

I. General information

NPI: 1366621393
Provider Name (Legal Business Name): MARCELLO CHERCHI M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N MICHIGAN AVE SUITE 410
CHICAGO IL
60611-2826
US

IV. Provider business mailing address

645 N MICHIGAN AVE SUITE 410
CHICAGO IL
60611-2826
US

V. Phone/Fax

Practice location:
  • Phone: 312-274-0197
  • Fax: 312-376-8707
Mailing address:
  • Phone: 312-274-0197
  • Fax: 312-376-8707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036114465
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: