Provider Demographics
NPI:1225397706
Name:WOOD, MARIA D (PAC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:WOOD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:D
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1051 W US ROUTE 6
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-4200
Mailing Address - Country:US
Mailing Address - Phone:815-942-4875
Mailing Address - Fax:815-942-5046
Practice Address - Street 1:1051 W US ROUTE 6
Practice Address - Street 2:SUITE 100
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-4200
Practice Address - Country:US
Practice Address - Phone:815-942-4875
Practice Address - Fax:815-942-5046
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004321363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
208887020OtherLOCALITY 15 MCR
370830025OtherLOCALITY 99
OTH000Medicare UPIN