Provider Demographics
NPI:1063652204
Name:MCINTYRE, MARIS FAYE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIS
Middle Name:FAYE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345A W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1419
Mailing Address - Country:US
Mailing Address - Phone:630-601-3434
Mailing Address - Fax:331-775-2833
Practice Address - Street 1:345A W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1419
Practice Address - Country:US
Practice Address - Phone:630-601-3434
Practice Address - Fax:331-775-2833
Is Sole Proprietor?:No
Enumeration Date:2009-02-28
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125050879207P00000X
IL036.125627207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine