Provider Demographics
NPI:1558307272
Name:MARCHOSKY, JOSE A (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:MARCHOSKY
Suffix:
Gender:M
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:PO BOX 4520
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-4520
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-991-8960
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:SUITE 54 W
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-878-0808
Practice Address - Fax:314-878-0847
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4651174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101144OtherHEALTHLINK
MOA28694OtherMERCY
MO000014163OtherMEDICARE PTAN
MO0600032OtherUHC
MO194767OtherGHP
MO200536888OtherTAX ID#
MO22527OtherBCBS
MOP00110866OtherRR MEDICARE
MO200536888OtherTAX ID#
MO916044163Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER