Provider Demographics
NPI:1164878328
Name:MAWST, PEARL
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:
Last Name:MAWST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 VOLLMER RD STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1122
Mailing Address - Country:US
Mailing Address - Phone:708-481-9800
Mailing Address - Fax:708-481-9808
Practice Address - Street 1:3212 VOLLMER RD STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1122
Practice Address - Country:US
Practice Address - Phone:708-481-9800
Practice Address - Fax:708-481-9808
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL372969247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208178Medicare PIN