Provider Demographics
NPI:1578538492
Name:MARSHALL, WENDY J (MD, FACS)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BARNEY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5296
Mailing Address - Country:US
Mailing Address - Phone:815-744-0330
Mailing Address - Fax:815-744-0445
Practice Address - Street 1:300 BARNEY DR
Practice Address - Street 2:SUITE A
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5296
Practice Address - Country:US
Practice Address - Phone:815-744-0330
Practice Address - Fax:815-744-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075261208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL69988OtherHEALTH ALLIANCE, URBANA
IL9930030OtherBC/BS OF ILLINOIS
IL036075261Medicaid
IL4226783OtherAETNA
IL4226783OtherAETNA
IL69988OtherHEALTH ALLIANCE, URBANA
ILC47735Medicare UPIN