Basic Information
| Provider Information | |||||||||
| NPI: | 1619945797 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARCOTTE | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | B | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15900 W 101ST AVE | ||||||||
| Address2: | MARCOTTE MEDICAL GROUP, SC | ||||||||
| City: | DYER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193656333 | ||||||||
| FaxNumber: | 2193658291 | ||||||||
| Practice Location | |||||||||
| Address1: | 15900 W 101ST AVE | ||||||||
| Address2: | |||||||||
| City: | DYER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193656333 | ||||||||
| FaxNumber: | 2193658291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036112482 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 02002860A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9932077 | 01 | IL | BCBS | OTHER | 90000082 | 01 | IL | BCBS | OTHER | DE6640 | 01 | IN | RAILROAD-DYER GROUP | OTHER | P00333647 | 01 | IN | RAILROAD-DYER | OTHER | 036112482 | 05 | IL | MEDICAID | 000000376384 | 01 | IN | BCBS | OTHER | 000000483369 | 01 | IN | ANTHEM | OTHER | 036112482 | 01 | IL | ILLINOIS PUBLIC AID | OTHER | P00254983 | 01 | IN | RAILROAD MEDICARE | OTHER |