Active NPI
Markia Lenise Pettway, DO
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1154124287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 125086793
- Practice address
- 3860 W Ogden Ave
Chicago, IL 60623-2460 - Phone
- (872) 588-3016
- NPI assigned
- Apr 1, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 125086793 | IL | Primary |
Addresses
Primary practice location
3860 W Ogden Ave
Chicago, IL 60623-2460
Mailing address
857 Cammack Rd
Birmingham, AL 35211-5961
Phone (205) 410-2540
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125086793 | IL | MD | Family Medicine Physician |
Interoperability endpoints
- mlenisepettway749677@direct.ochin.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753833600000",
"number": "1154124287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "857 CAMMACK RD",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352115961",
"telephone_number": "205-410-2540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3860 W OGDEN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606232460",
"telephone_number": "872-588-3016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTWAY",
"first_name": "MARKIA",
"middle_name": "LENISE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-04-01",
"last_updated": "2025-07-30",
"certification_date": "2025-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "125086793",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.