Individual
TREVOR J MARCOTTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
15900 W 101ST AVE, DYER, IN 46311
(219) 365-6333
(219) 365-8291
Mailing address
15900 W 101ST AVE, MARCOTTE MEDICAL GROUP, SC, DYER, IN 46311
(219) 365-6333
(219) 365-8291
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0036110052
IL
207Q00000X
Family Medicine Physician
Primary
02002588A
IN
207Q00000X
Family Medicine Physician
036110052
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000363442
ANTHEM
IN
05
—
036110052
—
IL
05
—
200494280A
—
IN
01
—
9932077
BCBS
IL
01
—
P00158260
RAILROAD
IL
01
—
P00307566
RAILROAD
IN
Enumeration date
05/22/2006
Last updated
04/08/2021
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