MEDICARE: MS. MARIA O'CONNOR 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	085002302	IL

General Provider Information

NPI Number	:	1316114929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA O'CONNOR PA-C

Provider Business Mailing Address
First Line	:	1474 W CARMEN AVE # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2813
Country	:	US
Telephone Number	:	773-307-2873
Fax Number	:	312-942-2359

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST STE 328
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3852
Country	:	US
Telephone Number	:	312-942-8106
Fax Number	:	312-942-2359

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

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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