Provider Demographics
NPI:1104879477
Name:MARCOTTE, CHRISTINE M (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:MARCOTTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15900 W 101ST AVE
Mailing Address - Street 2:MARCOTTE MEDICAL GROUP, SC
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311
Mailing Address - Country:US
Mailing Address - Phone:219-365-6333
Mailing Address - Fax:219-365-8291
Practice Address - Street 1:15900 W 101ST AVE
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311
Practice Address - Country:US
Practice Address - Phone:219-365-6333
Practice Address - Fax:219-365-8291
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02201263A207Q00000X
IL036085404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCK6207OtherRAILROAD - GROUP
IL080191173OtherRAILROAD
INP00307560OtherRAILROAD
IN200160420AMedicaid
INDE6640OtherRAILROAD-GROUP
IN000000366439OtherANTHEM
IL036085404Medicaid
IL9932077OtherBCBS
IN200160420AMedicaid
IL9932077OtherBCBS
IL036085404Medicaid
200760AMedicare PIN
INF57807Medicare UPIN
IN200760AMedicare PIN
IN200760Medicare PIN