MEDICARE: MAUREEN V DAVE PA-C

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	363AM0700X	Medical Physician Assistant	PA04682	TX

General Provider Information

NPI Number	:	1154441020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN V DAVE PA-C

Provider Business Mailing Address
First Line	:	125 S CLARK ST STE 900
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60603-4043
Country	:	US
Telephone Number	:	512-988-5355
Fax Number	:	512-323-0307

Provider Business Practice Location Address
First Line	:	799 LOUIS HENNA BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-7874
Country	:	US
Telephone Number	:	512-988-5355
Fax Number	:	512-323-0307

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	02/08/2023

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Directions to “ MAUREEN V DAVE PA-C” Practice Location

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