Provider Demographics
NPI:1285018846
Name:MAVES MEDICAL LTD
Entity Type:Organization
Organization Name:MAVES MEDICAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-731-9663
Mailing Address - Street 1:11316 W WADSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60099-3367
Mailing Address - Country:US
Mailing Address - Phone:847-731-9663
Mailing Address - Fax:847-731-9664
Practice Address - Street 1:11316 W WADSWORTH RD
Practice Address - Street 2:
Practice Address - City:BEACH PARK
Practice Address - State:IL
Practice Address - Zip Code:60099-3367
Practice Address - Country:US
Practice Address - Phone:847-731-9663
Practice Address - Fax:847-731-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087825Medicaid
IL123163400OtherDEPT OF LABOR
IL123163400OtherDEPT OF LABOR