Provider Demographics
NPI:1609187707
Name:FRICCHIONE, MARIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIELLE
Middle Name:
Last Name:FRICCHIONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4219
Mailing Address - Country:US
Mailing Address - Phone:312-746-5382
Mailing Address - Fax:
Practice Address - Street 1:2160 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4219
Practice Address - Country:US
Practice Address - Phone:312-746-5382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130640208000000X
IL125058778208000000X
IL036-1306402080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics