Provider Demographics
NPI:1528009826
Name:MARJERIE M BADILLA M.D. S.C.
Entity Type:Organization
Organization Name:MARJERIE M BADILLA M.D. S.C.
Other - Org Name:SKIN AND HAIR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALCANTARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-583-6955
Mailing Address - Street 1:2510 W IRVING PARK RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3716
Mailing Address - Country:US
Mailing Address - Phone:773-583-6955
Mailing Address - Fax:773-604-2201
Practice Address - Street 1:2510 W IRVING PARK RD
Practice Address - Street 2:UNIT D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3716
Practice Address - Country:US
Practice Address - Phone:773-583-6955
Practice Address - Fax:773-604-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051999-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051999-1Medicaid
ILK31490Medicare ID - Type Unspecified
ILE-43651Medicare UPIN