Provider Demographics
NPI:1770753204
Name:MARQUETTE ORTHOPEDIC LTD
Entity type:Organization
Organization Name:MARQUETTE ORTHOPEDIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAWCHYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-586-0811
Mailing Address - Street 1:6925 W ARCHER AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2319
Mailing Address - Country:US
Mailing Address - Phone:773-586-0811
Mailing Address - Fax:773-586-0812
Practice Address - Street 1:6925 W ARCHER AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2319
Practice Address - Country:US
Practice Address - Phone:773-586-0811
Practice Address - Fax:773-586-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360 44356207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044356Medicaid
IL0001616762OtherBLUE CROSS BLUE SHIELD
IL0001616762OtherBLUE CROSS BLUE SHIELD