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General NPI Number Information
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NPI Number | 1821560475
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Entity Type | Organization
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Legal Business Name | MARIA J. MYNATT, MD, PLLC
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 250 PARKWAY DR STE 150
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-4340
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Country | US
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Telephone | 847-325-5467
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Fax |
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Provider Business Mailing Address
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Address Line | 455 WOODLAWN AVE
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City | GLENCOE
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State | IL
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Zip | 60022-2175
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Country | US
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Telephone | 847-791-7799
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. MARIA JOSEPHINE MYNATT
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Credential | MD
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Telephone | 847-325-5467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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