Provider Demographics
NPI:1548062326
Name:MARELZ, LLC
Entity type:Organization
Organization Name:MARELZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BUKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUSOTE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:469-638-3162
Mailing Address - Street 1:1600 W GREENLEAF AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2704
Mailing Address - Country:US
Mailing Address - Phone:469-638-3162
Mailing Address - Fax:
Practice Address - Street 1:1600 W GREENLEAF AVE APT 108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2704
Practice Address - Country:US
Practice Address - Phone:469-638-3162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty