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General NPI Number Information
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NPI Number | 1043507536
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Entity Type | Organization
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Legal Business Name | MARY-ANN M. MATHIAS, M.D., S.C.
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 670 W WAYMAN ST APT 1203
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City | CHICAGO
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State | IL
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Zip | 60661-1704
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Country | US
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Telephone | 773-988-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 670 W WAYMAN ST APT 1203
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City | CHICAGO
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State | IL
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Zip | 60661-1704
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Country | US
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Telephone | 773-988-3151
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY-ANN MARGARET MATHIAS
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Credential | M.D.
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Telephone | 773-988-3151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036119270
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License Number State | IL
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