MEDICARE: MARIE LOUISE MOHRBACHER DO

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1912765587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE LOUISE MOHRBACHER DO

Provider Business Mailing Address
First Line	:	3134 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4414
Country	:	US
Telephone Number	:	773-296-5420
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 S 200 E UNIT 321
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-2868
Country	:	US
Telephone Number	:	651-587-4793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	04/10/2025

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