Healthcare Provider Details

I. General information

NPI: 1144452699
Provider Name (Legal Business Name): DR. MAGGIE ISAAC BISHAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAGGIE ISAAC

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 W OGDEN AVE
CHICAGO IL
60623-2460
US

IV. Provider business mailing address

3860 W OGDEN AVE
CHICAGO IL
60623-2460
US

V. Phone/Fax

Practice location:
  • Phone: 773-843-3601
  • Fax: 773-843-2704
Mailing address:
  • Phone: 773-843-3601
  • Fax: 773-843-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.007684
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: