Provider Demographics
NPI:1093721094
Name:ESPEJO, MARIA C (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:ESPEJO
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 1:5425 W SPRING CREEK PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4248
Mailing Address - Country:US
Mailing Address - Phone:217-779-5088
Mailing Address - Fax:
Practice Address - Street 1:5425 W SPRING CREEK PKWY STE 120
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4248
Practice Address - Country:US
Practice Address - Phone:217-779-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8983208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115146Medicaid
ILK25993Medicare ID - Type UnspecifiedWPS
IL036115146Medicaid