Provider Demographics
NPI:1033122684
Name:PIERCE, MAREALITA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:MAREALITA
Middle Name:MARIA
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5400 S HYDE PARK BLVD
Mailing Address - Street 2:UNIT A2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5828
Mailing Address - Country:US
Mailing Address - Phone:773-955-2852
Mailing Address - Fax:773-955-2852
Practice Address - Street 1:1525 E 53RD ST
Practice Address - Street 2:SUITE 832
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4557
Practice Address - Country:US
Practice Address - Phone:773-643-2550
Practice Address - Fax:773-643-3603
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-096342208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG60266Medicare UPIN