Healthcare Provider Details

I. General information

NPI: 1790953388
Provider Name (Legal Business Name): SARZ MAXWELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W ARDMORE AVE #104
CHICAGO IL
60660-3700
US

IV. Provider business mailing address

1020 W ARDMORE AVE #2M
CHICAGO IL
60660-3700
US

V. Phone/Fax

Practice location:
  • Phone: 773-569-8997
  • Fax: 773-561-2499
Mailing address:
  • Phone: 773-569-8997
  • Fax: 773-561-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: