Healthcare Provider Details

I. General information

NPI: 1033537659
Provider Name (Legal Business Name): MARCO BERTUCCI ZOCCALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARCO ZOCCALI MD

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE # MC6040
CHICAGO IL
60637
US

IV. Provider business mailing address

161 FORT WASHINGTON AVE FL 8
NEW YORK NY
10032-3729
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6337
  • Fax:
Mailing address:
  • Phone: 212-342-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036145742
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number036145742
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number300744
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: