Healthcare Provider Details

I. General information

NPI: 1558550996
Provider Name (Legal Business Name): MARCI PUGNALE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCI NEIDICH MD

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5999 NEW WILKE RD BLDG 1
ROLLING MEADOWS IL
60008-4506
US

IV. Provider business mailing address

5999 NEW WILKE RD BLDG 1
ROLLING MEADOWS IL
60008-4506
US

V. Phone/Fax

Practice location:
  • Phone: 847-259-2530
  • Fax: 847-259-4930
Mailing address:
  • Phone: 847-259-2530
  • Fax: 847-259-4930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036-132281
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number57013981
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: