Individual
DR. CHARLES J MARCUCCILLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
180 HARVESTER DR, SUITE 110, BURR RIDGE, IL 60527-7594
(773) 702-1150
Mailing address
5841 S MARYLAND AVE, DEPT OF PEDIATRICS, MC 3055, CHICAGO, IL 60637-1447
(773) 702-6487
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
036102274
IL
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
036102274
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34818000
—
WI
Enumeration date
05/17/2006
Last updated
09/19/2024
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