Provider Demographics
NPI:1649224734
Name:MARCOTTE, TREVOR J (DO)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:J
Last Name:MARCOTTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15900 W 101ST AVE
Mailing Address - Street 2:MARCOTTE MEDICAL GROUP, SC
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311
Mailing Address - Country:US
Mailing Address - Phone:219-365-6333
Mailing Address - Fax:219-365-8291
Practice Address - Street 1:15900 W 101ST AVE
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311
Practice Address - Country:US
Practice Address - Phone:219-365-6333
Practice Address - Fax:219-365-8291
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110052207Q00000X
IL0036110052207Q00000X
IN02002588A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932077OtherBCBS
IN000000363442OtherANTHEM
IN200494280AMedicaid
IL036110052Medicaid
INP00307566OtherRAILROAD
ILP00158260OtherRAILROAD
IN000000363442OtherANTHEM
IL9932077OtherBCBS
IL036110052Medicaid
IN200494280AMedicaid
IL203367Medicare PIN
IL215996Medicare PIN
INI09810Medicare UPIN
IN200760CMedicare PIN