1306175005 NPI number — MORRIS MAUER MD SC

Table of content: (NPI 1306175005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306175005 NPI number — MORRIS MAUER MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRIS MAUER MD SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306175005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2010 N HARLEM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMWOOD PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60707-3119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-452-1111
Provider Business Mailing Address Fax Number:
708-452-4593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 W DEMPSTER ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
PARK RIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60068-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-299-7888
Provider Business Practice Location Address Fax Number:
708-452-4593
Provider Enumeration Date:
12/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MAUER
Authorized Official First Name:
MORRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
312-813-8240

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  036070419 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DP9686 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 21620215 . This is a "BLUE SHIELD OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1215933825 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036070419 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com