Provider Demographics
NPI:1407802242
Name:PRINZ, PAUL T (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:T
Last Name:PRINZ
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 1:675 W NORTH AVE
Mailing Address - Street 2:SUITE 607
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1634
Mailing Address - Country:US
Mailing Address - Phone:708-681-7809
Mailing Address - Fax:708-681-7808
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 607
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-681-7809
Practice Address - Fax:708-681-7808
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081375Medicaid
IL01625553OtherBC/BS
IL568290Medicare PIN
IL01625553OtherBC/BS
ILE62192Medicare UPIN