Provider Demographics
NPI:1306194824
Name:OO, THET MAW (MD,)
Entity Type:Individual
Prefix:
First Name:THET MAW
Middle Name:
Last Name:OO
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 N SHERIDAN RD
Mailing Address - Street 2:APT 1407
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5864
Mailing Address - Country:US
Mailing Address - Phone:718-416-5720
Mailing Address - Fax:
Practice Address - Street 1:2970 N SHERIDAN RD
Practice Address - Street 2:APT 1407
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5864
Practice Address - Country:US
Practice Address - Phone:718-416-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program