Antonio Marra, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036038919 Issued in IL

Practice address

30 E 15TH St Ste 205
Chicago Heights, IL 60411-3476

Phone

(708) 755-4401

NPI assigned

Nov 20, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Antonio Marra

  • Primary Care Clinic/Center
  • Chicago Heights, IL
  • NPI 1659777530
  NPD (past) Authorized official
• Boulevard Pediatrics SC

  • Pediatrics Physician
  • Chicago Heights, IL
  • NPI 1558445122
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1225435225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E 15TH ST STE 205",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604113476",
            "telephone_number": "708-755-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E 15TH ST STE 205",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604113476",
            "telephone_number": "708-755-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARRA",
        "first_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-11-20",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036038919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036038919",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debra Madden, NP
• Smita Mahajan
• Mangram Dental, P.C.
• Karen Elizabeth Mannos, MSW
• Marion Jackson Enterprises Inc
• Marshall Shikami DDS PC
• Camisha Martin
• Victoria Mason
• Haley M Masters, MD
• Tenisha Shawan McCaskill, M.D

• Pediatrics Physician in Chicago Heights, IL
• Providers in Chicago Heights, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.