Provider Demographics
NPI:1033117213
Name:VALENA, MARLYN (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARLYN
Middle Name:
Last Name:VALENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4717
Practice Address - Country:US
Practice Address - Phone:847-214-5760
Practice Address - Fax:847-214-5777
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093509208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532170OtherBLUE CROSS BLUE SHIELD
IL036093509Medicaid
ILDB0387OtherRAILROAD MEDICARE GROUP
ILG58931Medicare UPIN
ILDB0387OtherRAILROAD MEDICARE GROUP