Provider Demographics
NPI:1548821598
Name:HACHE MARLIERE, MANUEL ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:MANUEL ANTONIO
Middle Name:
Last Name:HACHE MARLIERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST STE 10
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3849
Mailing Address - Country:US
Mailing Address - Phone:312-942-6744
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 10
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3849
Practice Address - Country:US
Practice Address - Phone:312-942-6744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036164871207RP1001X, 207R00000X, 207RC0200X
NY319094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine