Provider Demographics
NPI:1750349346
Name:MARECEK, RAYMOND L (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:L
Last Name:MARECEK
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 1:2215 WILDWOOD AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5089
Mailing Address - Country:US
Mailing Address - Phone:501-833-3833
Mailing Address - Fax:501-833-8191
Practice Address - Street 1:2215 WILDWOOD AVE
Practice Address - Street 2:STE 105
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72120-5089
Practice Address - Country:US
Practice Address - Phone:501-833-3833
Practice Address - Fax:501-833-8191
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC3284207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104394001Medicaid
C68198Medicare UPIN
51481Medicare ID - Type Unspecified