Basic Information
Provider Information
NPI: 1245866177
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIGGETT
FirstName: MARJORIE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 251 E HURON ST
Address2:  
City: CHICAGO
State: IL
PostalCode: 606113055
CountryCode: US
TelephoneNumber: 3122274000
FaxNumber:  
Practice Location
Address1: 251 E HURON ST
Address2:  
City: CHICAGO
State: IL
PostalCode: 606113055
CountryCode: US
TelephoneNumber: 3122274000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/23/2020
LastUpdateDate: 06/15/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/15/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
208600000X125.075531ILY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


Home