Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036-119215 | IL |
N | 207X00000X | Orthopaedic Surgeon | 51315-20 | WI |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 036-119215 | IL |
N | 207XS0106X | Orthopaedic Hand Surgeon | 51315-20 | WI |
NPI | 1265411326 |
---|---|
Provider Name | Dr. Marcus Gregory Talerico |
First Address | Lincolnshire, IL 60069-3094 |
Second Address | Lincolnshire, IL 60069-3094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 03/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
61008 | DEAN HEALTH INSURANCE (01) | WI |