Healthcare Provider Details

I. General information

NPI: 1235361726
Provider Name (Legal Business Name): MARIA M DAI P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 95TH ST
NAPERVILLE IL
60564-8459
US

IV. Provider business mailing address

546 WHITTIER AVE
GLEN ELLYN IL
60137-4767
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-6953
  • Fax:
Mailing address:
  • Phone: 920-207-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21475
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.005036
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA06301
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: