Provider Demographics
NPI:1356654487
Name:ORVIETO, MARCELO A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELO
Middle Name:A
Last Name:ORVIETO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5841 S MARYLAND AVE STE J653
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-834-9889
Mailing Address - Fax:773-702-1001
Practice Address - Street 1:5841 S MARYLAND AVE STE J653
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-834-9889
Practice Address - Fax:773-702-1001
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.125604208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology