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General NPI Number Information
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NPI Number | 1063652204
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Entity Type | Individual
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Provider Name | MARIS FAYE MCINTYRE D.O.
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Gender | Female
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Dates
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Enumeration Date | 02/28/2009
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | 345A W OGDEN AVE
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City | WESTMONT
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State | IL
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Zip | 60559-1419
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Country | US
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Telephone | 630-601-3434
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Fax | 331-775-2833
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Provider Business Mailing Address
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Address Line | 345A W OGDEN AVE
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City | WESTMONT
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State | IL
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Zip | 60559-1419
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Country | US
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Telephone | 630-601-3434
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Fax | 331-775-2833
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 125050879
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.125627
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License Number State | IL
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