Provider Demographics
NPI:1265411326
Name:TALERICO, MARCUS GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:GREGORY
Last Name:TALERICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VILLAGE GRN
Mailing Address - Street 2:#120
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3094
Mailing Address - Country:US
Mailing Address - Phone:847-634-1766
Mailing Address - Fax:
Practice Address - Street 1:100 VILLAGE GRN
Practice Address - Street 2:#120
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3094
Practice Address - Country:US
Practice Address - Phone:847-634-1766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-119215207X00000X, 207XS0106X
WI51315-20207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI61008OtherDEAN HEALTH INSURANCE
ILIL5520006Medicare PIN
WI741501760Medicare PIN
WI61008OtherDEAN HEALTH INSURANCE