Healthcare Provider Details

I. General information

NPI: 1447886528
Provider Name (Legal Business Name): TETYANA MARSHALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TETYANA OSADCHUK MD

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE DEPARTMENT OF ANESTHESIA
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

150 HARVESTER DR STE 300
BURR RIDGE IL
60527-5965
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2760
  • Fax: 847-570-2921
Mailing address:
  • Phone: 888-824-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036173099
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036173099
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: