Organization
BOULEVARD PEDIATRICS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIO MARRA MD (OWNER)
(708) 755-4401
Entity
Organization
Contact information
Practice address
30 E 15TH STREET, SUITE 205, CHICAGO HEIGHTS, IL 60411
(708) 755-4401
(708) 755-4479
Mailing address
30 E 15TH STREET, SUITE 205, CHICAGO HEIGHTS, IL 60411
(708) 755-4401
(708) 755-4479
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
IL
Other
Enumeration date
10/24/2006
Last updated
08/22/2020
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