Provider Demographics
NPI:1184678377
Name:MARCOTTE, SUSAN E (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:MARCOTTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16527 106TH CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4545
Mailing Address - Country:US
Mailing Address - Phone:708-675-1070
Mailing Address - Fax:708-675-1073
Practice Address - Street 1:16527 106TH CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4545
Practice Address - Country:US
Practice Address - Phone:708-675-1070
Practice Address - Fax:708-675-1073
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075405Medicaid
IL036075405Medicaid
ILL65628Medicare PIN