Healthcare Provider Details

I. General information

NPI: 1881872984
Provider Name (Legal Business Name): MARIA HORVAT MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEERPATH
CHARLESTON IL
61920-9427
US

IV. Provider business mailing address

100 DEERPATH
CHARLESTON IL
61920-9427
US

V. Phone/Fax

Practice location:
  • Phone: 217-345-2727
  • Fax: 217-345-2781
Mailing address:
  • Phone: 217-345-2727
  • Fax: 217-345-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MARIA HORVAT
Title or Position: PRESIDENT
Credential: MD
Phone: 217-345-2727