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General NPI Number Information
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NPI Number | 1033122684
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Entity Type | Individual
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Provider Name | MAREALITA MARIA PIERCE M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1525 E 53RD ST SUITE 832
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City | CHICAGO
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State | IL
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Zip | 60615-4557
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Country | US
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Telephone | 773-643-2550
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Fax | 773-643-3603
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Provider Business Mailing Address
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Address Line | 5400 S HYDE PARK BLVD UNIT A2
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City | CHICAGO
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State | IL
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Zip | 60615-5828
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Country | US
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Telephone | 773-955-2852
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Fax | 773-955-2852
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036-096342
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License Number State | IL
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