Provider Demographics
NPI:1629164793
Name:MARSHALL, JACQUELINE H (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:H
Last Name:MARSHALL
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 1:17335 ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3777
Mailing Address - Country:US
Mailing Address - Phone:708-889-1126
Mailing Address - Fax:
Practice Address - Street 1:13450 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:ROBBINS
Practice Address - State:IL
Practice Address - Zip Code:60472-1639
Practice Address - Country:US
Practice Address - Phone:708-293-8100
Practice Address - Fax:708-293-8197
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082757208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics