Provider Demographics
NPI:1306989199
Name:MARASCO, ARMAND. MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:ARMAND.
Middle Name:MICHAEL
Last Name:MARASCO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6211
Mailing Address - Country:US
Mailing Address - Phone:219-769-3381
Mailing Address - Fax:219-769-3880
Practice Address - Street 1:420 E 86TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6211
Practice Address - Country:US
Practice Address - Phone:219-769-3381
Practice Address - Fax:219-769-3880
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000376213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL61100073OtherBLUE CROSS BLUE SHIELD IL
IN000000084011OtherANTHEM
IN0805140001OtherDME SUPPLIER
IN100142220-AMedicaid
IL61100073OtherBLUE CROSS BLUE SHIELD IL
IN0805140001OtherDME SUPPLIER