Active NPI
Marco Antonio Guerra, MD
- Pediatrics Physician
- Chicago, IL
National Provider Identifier
1639291297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036076861
- Practice address
- 966 W 21St St
Chicago, IL 60608-4511 - Phone
- (773) 254-1400
- Fax
- (773) 650-1239
- NPI assigned
- Apr 4, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036076861 | IL | Primary |
Addresses
Primary practice location
966 W 21St St
Chicago, IL 60608-4511
Mailing address
966 W 21St St
Chicago, IL 60608-4511
Phone (773) 254-1400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | IL |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036076861 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507161600000",
"number": "1639291297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "966 W 21ST ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606084511",
"telephone_number": "773-254-1400",
"fax_number": "773-650-1239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "966 W 21ST ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606084511",
"telephone_number": "773-254-1400",
"fax_number": "773-650-1239"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUERRA",
"first_name": "MARCO",
"middle_name": "ANTONIO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-04",
"last_updated": "2017-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036076861",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "IL"
}
],
"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 Oct 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.