MEDICARE: DR. MARY-ANN M MATHIAS 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	207W00000X	Ophthalmology Physician	125047242	IL

General Provider Information

NPI Number	:	1851510416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY-ANN M MATHIAS MD

Provider Business Mailing Address
First Line	:	670 W WAYMAN ST
Second Line	:	1203
City	:	CHICAGO
State	:	IL
Zip	:	60661-1704
Country	:	US
Telephone Number	:	773-988-3151
Fax Number	:	312-291-9842

Provider Business Practice Location Address
First Line	:	1588 N. ARLINGTON HEIGHTS ROAD
Second Line	:	ARLINGTON HEIGHTS
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004
Country	:	US
Telephone Number	:	847-392-9220
Fax Number	:	847-392-9252

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	09/21/2011

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