1831647205 NPI number — MR. MARCELO ROCHA DE SOUSA CRUZ M.D.

Table of content: MR. MARCELO ROCHA DE SOUSA CRUZ M.D. (NPI 1831647205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831647205 NPI number — MR. MARCELO ROCHA DE SOUSA CRUZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
MARCELO
Provider Middle Name:
ROCHA DE SOUSA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831647205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 EAST SUPERIOR STREET, SUITE 01-023
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-472-1234
Provider Business Mailing Address Fax Number:
312-472-0564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
233 EAST SUPERIOR STREET
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-472-1234
Provider Business Practice Location Address Fax Number:
312-472-0574
Provider Enumeration Date:
09/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: 125069681 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1831647205 . This is a "NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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