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General NPI Number Information
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NPI Number | 1033604525
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Entity Type | Organization
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Legal Business Name | MWM MEDICAL, SC
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 1725 W HARRISON ST STE 408
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City | CHICAGO
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State | IL
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Zip | 60612-3852
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Country | US
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Telephone | 312-718-2229
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Fax | 773-248-7630
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Provider Business Mailing Address
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Address Line | 341 W WELLINGTON AVE
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City | CHICAGO
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State | IL
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Zip | 60657-5636
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Country | US
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Telephone | 312-718-2229
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Fax | 773-248-7630
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARY WOOD MOLO
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Credential | MD
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Telephone | 312-718-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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