Provider Demographics
NPI:1154581783
Name:MACRINICI, VALENTINA (MD)
Entity type:Individual
Prefix:
First Name:VALENTINA
Middle Name:
Last Name:MACRINICI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S SCHMIDT RD
Mailing Address - Street 2:230
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:630-312-2000
Mailing Address - Fax:
Practice Address - Street 1:420 S SCHMIDT RD
Practice Address - Street 2:SUITE 230
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440
Practice Address - Country:US
Practice Address - Phone:630-312-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-127715207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208256OtherMEDICARE GROUP PTAN FOR INDIV PTAN OF 208256005
IL208256005Medicare PIN
ILC31261OtherMEDICARE RR GROUP ID#
IL336140004Medicare PIN
ILP00943078OtherMEDICARE RAIL ROAD
IL205474005Medicare PIN
IL205474OtherMEDICARE GROUP PTAN FOR INDIVIDUAL PTAN 205474005
IL336140OtherMEDICARE GROUP PTAN FOR INDIV PTAN 336140004
KY40637OtherKENTUCKY BOARD OF MEDICAL LICENSURE