Healthcare Provider Details

I. General information

NPI: 1104376912
Provider Name (Legal Business Name): PAIGE MAHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST STE 300
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

2626 N LAKEVIEW AVE 1011
CHICAGO IL
60614-6173
US

V. Phone/Fax

Practice location:
  • Phone: 312-432-2381
  • Fax: 708-409-5179
Mailing address:
  • Phone: 708-828-9509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: