Healthcare Provider Details

I. General information

NPI: 1104879477
Provider Name (Legal Business Name): CHRISTINE M MARCOTTE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/08/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 W 101ST AVE
DYER IN
46311
US

IV. Provider business mailing address

15900 W 101ST AVE MARCOTTE MEDICAL GROUP, SC
DYER IN
46311
US

V. Phone/Fax

Practice location:
  • Phone: 219-365-6333
  • Fax: 219-365-8291
Mailing address:
  • Phone: 219-365-6333
  • Fax: 219-365-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02201263A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036085404
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: