MEDICARE: THIDA MAW I MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036077605	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114927191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THIDA MAW I MD

Provider Business Mailing Address
First Line	:	892 HAMPTON DR
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60188-2975
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	892 HAMPTON DR
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60188-2975
Country	:	US
Telephone Number	:	630-248-4873
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	08/31/2023

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