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NPI Code Detail

MEDICARE: DR. MARY S MAISH MD

MEDICARE: DR. MARY S MAISH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician4301513301MI
2208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician01096488AIN
3208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician036147674IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750316774
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY S MAISH MD
Provider Business Mailing Address
First Line : 800 N WESTMORELAND RD STE 100
Second Line :
City : LAKE FOREST
State : IL
Zip : 60045-1671
Country : US
Telephone Number : 224-271-4650
Fax Number : 224-234-4336
Provider Business Practice Location Address
First Line : 800 N WESTMORELAND RD STE 100
Second Line :
City : LAKE FOREST
State : IL
Zip : 60045-1671
Country : US
Telephone Number : 224-271-4650
Fax Number : 224-234-4336
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 08/25/2025

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Directions to “ DR. MARY S MAISH MD” Practice Location

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