Provider Demographics
NPI:1083782908
Name:TANQUILUT, MARLENE JUCO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:JUCO
Last Name:TANQUILUT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:200 SOUTH GREENLEAF ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-336-0770
Mailing Address - Fax:847-336-0159
Practice Address - Street 1:200 SOUTH GREENLEAF ST
Practice Address - Street 2:SUITE E
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-336-0770
Practice Address - Fax:847-336-0159
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics