Provider Demographics
NPI:1457485567
Name:PONTON, MARIA TERESA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:PONTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3500
Mailing Address - Country:US
Mailing Address - Phone:847-344-4372
Mailing Address - Fax:773-271-4540
Practice Address - Street 1:2740 W FOSTER AVE STE 313
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3524
Practice Address - Country:US
Practice Address - Phone:773-271-3344
Practice Address - Fax:773-271-4540
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360948322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry