Provider Demographics
NPI:1083618078
Name:SACRIS, MARIA O (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:O
Last Name:SACRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1338
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-1338
Mailing Address - Country:US
Mailing Address - Phone:219-462-4042
Mailing Address - Fax:219-462-1444
Practice Address - Street 1:2000 ROOSEVELT RD
Practice Address - Street 2:STE 207
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2802
Practice Address - Country:US
Practice Address - Phone:219-462-4042
Practice Address - Fax:219-462-1444
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ01025728207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL90000239OtherBLUE CROSS OF ILL
IN100076930AMedicaid
IN000000109115OtherANTHEM BC/BS
IL90000239OtherBLUE CROSS OF ILL
INB29253Medicare UPIN