Provider Demographics
NPI:1750477097
Name:MARRESE, R ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:ANTHONY
Last Name:MARRESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROCCO
Other - Middle Name:ANTHONY
Other - Last Name:MARRESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:350 W COLUMBIA ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710
Mailing Address - Country:US
Mailing Address - Phone:812-424-3321
Mailing Address - Fax:812-424-3328
Practice Address - Street 1:350 W COLUMBIA ST
Practice Address - Street 2:SUITE 230
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710
Practice Address - Country:US
Practice Address - Phone:812-424-3321
Practice Address - Fax:812-424-3328
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024696207X00000X
MO111766207X00000X
FLME13714207X00000X
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0164366043OtherIPA
IL211805OtherMEDICARE
IL06022530OtherBCBS
IL0164366043Medicaid
IL0164366043Medicaid
IN836890Medicare PIN