DR. CHARLES J MARCUCCILLI (NPI# 1801849559) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801849559 |
| Entity Type | Individual |
| Full Name | DR. CHARLES J MARCUCCILLI |
| Credential | MD |
| Practice Address |
180 Harvester Dr Suite 110 Burr Ridge IL 60527-7594 |
| Mailing Address |
5841 S Maryland Ave Dept of Pediatrics, Mc 3055 Chicago IL 60637-1447 |
| Practice Telephone | 7737021150 |
| Mailing Telephone | 7737026487 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2013-11-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
48736 | WI | Allopathic & Osteopathic Physicians |
| Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
036102274 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 34818000 | 05 |
| Street Address |
180 HARVESTER DR SUITE 110 |
| City | BURR RIDGE |
| State | IL |
| Zip Code | 60527-7594 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386611903 | Bryan N Becker | Internal Medicine | 180 Harvester Dr, Suite 110, Burr Ridge, IL 60527-7594 | 2006-03-02 |
| 1144639527 | Andrew Richardson | Nurse Practitioner | 180 Harvester Dr, Suite 110, Burr Ridge, IL 60527-7594 | 2014-08-11 |
| 1720403843 | Joyce Eapen | Nurse Practitioner | 180 Harvester Dr, Suite 110, Burr Ridge, IL 60527-7594 | 2014-02-26 |
| 1902234941 | Brittany Beach | Internal Medicine | 180 Harvester Dr, Suite 110, Burr Ridge, IL 60527-7594 | 2013-10-30 |
| 1164850244 | Kimberly Salminen | Physician Assistant | 180 Harvester Dr, Suite 110, Burr Ridge, IL 60527-7594 | 2013-10-28 |
| 1992139281 | Kristine Marie Bowersox | Physician Assistant | 180 Harvester Dr, Suite 110, Burr Ridge, IL 60527-7594 | 2013-08-22 |
| 1255771093 | Eric Shappell | Emergency Medicine | 180 Harvester Dr, Suite 110, Burr Ridge, IL 60527 | 2013-06-25 |
| 1467895805 | Monica Rojas | Dietitian, Registered | 180 Harvester Dr, Suite 110, Burr Ridge, IL 60527-7594 | 2013-04-16 |
| 1699011189 | Leticia Lemus | Nurse Practitioner | 180 Harvester Dr, Burr Ridge, IL 60527-7594 | 2013-01-02 |
| 1487990156 | University of Chicago Physicians Group | Clinic/Center | 180 Harvester Dr, Suite 110, Burr Ridge, IL 60527-7594 | 2012-12-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023635364 | Crystal Mary Dirks | Occupational Therapy Assistant | 211 75th St, Burr Ridge, IL 60527 | 2020-07-02 |
| 1386276350 | Valerie Moreno-tucker | Counselor | 277 83rd St, Burr Ridge, Il 60527, Burr Ridge, IL 60527 | 2020-02-07 |
| 1831734763 | Annette Maria Zajac | Occupational Therapist | 16 91st St., Burr Ridge, IL 60527 | 2019-11-14 |
| 1568023109 | Jennifer Rogers | Counselor | 277 83rd St., Ste. D, Burr Ridge, IL 60527 | 2019-06-25 |
| 1710458526 | Dima Sibai Dds PC | Clinic/Center | 940 Plianfield Rd., Willowbrook, IL 60527 | 2018-12-06 |
| 1558850495 | Jeanie C. Lucy PC | Optometrist | 6340 Americana Drive Suite 1108, Willowbrook, IL 60527 | 2018-05-07 |
| 1538664032 | Athletico,ltd | Physical Therapist | 6860 N Frontage Rd Ste B, Burr Ridge, IL 60527 | 2018-03-27 |
| 1003314832 | Ams Wellness Pllc | Psychologist | 277 83rd St Ste D, Burr Ridge, IL 60527 | 2018-01-26 |
| 1023564671 | Natasa Manasovska | Dentist | 6111 Knollwood Rd, Apt. 103, Willowbrook, IL 60527 | 2016-09-01 |
| 1669927893 | Marie Ann Korallus | Nurse Practitioner | 7055 High Grove, Burr Ridge, IL 60527 | 2016-08-17 |
| Find all providers in zip 60527 | ||||
| Taxonomy Code | 2084N0402X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology with Special Qualifications in Child Neurology |
| A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700226206 | Aliesje Sorgeloos | Psychiatry & Neurology | 4220 W 95th St Ste 210, Oak Lawn, IL 60453 | 2013-06-28 |
| 1851558001 | Lubov Romantseva | Psychiatry & Neurology | 1725 W Harrison St Ste 718, Department of Pediatrics, Section of Child Neurology, Chicago, IL 60612-3863 | 2008-05-16 |
| 1154597029 | Children's Physician Group | Psychiatry & Neurology | 1473 Commerce Dr, Algonquin, IL 60102-5916 | 2008-05-01 |
| 1457484669 | Michelle Annette Melyn | Psychiatry & Neurology | 7777 West Lake St, River Forest, IL 60305 | 2007-03-14 |
| 1992856678 | Shakuntala Chhabria | Psychiatry & Neurology | 222s Greenleaf St 111, Gurnee, IL 60031-5705 | 2007-01-16 |
| 1053481929 | Rita Yadava M.d.s.c. | Psychiatry & Neurology | 1200 South York Rd, 4150, Elmhurst, IL 60126 | 2006-11-08 |
| 1356446306 | Leonard D Elkun Md Sc | Psychiatry & Neurology | 411 W Ontario St, Suite 402, Chicago, IL 60610-6945 | 2006-09-14 |
| 1023129145 | Leonard David Elkun | Psychiatry & Neurology | 411 W. Ontario St, Suite 402, Chicago, IL 60610-6945 | 2006-08-31 |
| 1184636805 | Shaku Chhabria Neurological Services Sc | Psychiatry & Neurology | 222 S Greenleaf St Ste 111, Gurnee, IL 60031-5705 | 2006-08-12 |
| 1811929003 | Charles Nash Swisher | Psychiatry & Neurology | 2515 N Clark Street, Suite, Chicago, IL 60614 | 2006-07-07 |
| Find all providers with the same taxonomy | ||||
| City | BURR RIDGE |
| Zip Code | 60527 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.