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General NPI Number Information
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NPI Number | 1083896914
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Entity Type | Organization
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Legal Business Name | MARIA MEDICAL LLC
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 550 E BOUGHTON RD SUITE 140
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2100
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Country | US
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Telephone | 630-226-9950
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Fax | 630-378-9952
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Provider Business Mailing Address
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Address Line | 1307 BRANDYWINE DR
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City | MUNSTER
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State | IN
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Zip | 46321-4331
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ANEMARIA LUTAS
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Credential |
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Telephone | 630-226-9950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036104904
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License Number State | IL
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