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NPI Code Detail

MEDICARE: MARQUETTE RADIOLOGY ASSOCIATES LLC

MEDICARE: MARQUETTE RADIOLOGY ASSOCIATES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10001634200OTHERILBCBS IL PIN

General Provider Information

NPI Number : 1427053552
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARQUETTE RADIOLOGY ASSOCIATES LLC
Provider Business Mailing Address
First Line : PO BOX 2153
Second Line :
City : BEDFORD PARK
State : IL
Zip : 60499-2153
Country : US
Telephone Number : 800-354-1088
Fax Number : 314-631-4491
Provider Business Practice Location Address
First Line : 2701 W 68TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-1813
Country : US
Telephone Number : 773-884-1662
Fax Number : 314-631-4491
Authorized Official
Title or Position : PRESIDENT/PROVIDER
Name : DR. FRANK M MARMO
Credential : MD
Telephone Number : 800-354-1088
Provider Enumeration Date : 06/16/2005
Last Update Date : 07/21/2022

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