Healthcare Provider Details

I. General information

NPI: 1740326719
Provider Name (Legal Business Name): ALEJANDRO MARCHINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 E NORRIS DR
OTTAWA IL
61350-3681
US

IV. Provider business mailing address

1614 E NORRIS DR
OTTAWA IL
61350-3681
US

V. Phone/Fax

Practice location:
  • Phone: 815-433-1010
  • Fax:
Mailing address:
  • Phone: 815-433-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-066147
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number172753
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: