Provider Demographics
NPI:1467631978
Name:CORRAL, MARIBEL (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:CORRAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6837
Mailing Address - Country:US
Mailing Address - Phone:773-523-1000
Mailing Address - Fax:773-843-1553
Practice Address - Street 1:3650 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3611
Practice Address - Country:US
Practice Address - Phone:312-698-9040
Practice Address - Fax:855-618-2276
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant