Provider Demographics
NPI:1710576657
Name:ALCANTARA, MARC (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 MOON LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1010
Mailing Address - Country:US
Mailing Address - Phone:847-278-3048
Mailing Address - Fax:
Practice Address - Street 1:2649 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3835
Practice Address - Country:US
Practice Address - Phone:773-717-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022699363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner