Provider Demographics
NPI:1497877880
Name:MYNATT, MARIA JOSEPHINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:JOSEPHINE
Last Name:MYNATT
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 1:455 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-2175
Mailing Address - Country:US
Mailing Address - Phone:847-835-4907
Mailing Address - Fax:
Practice Address - Street 1:250 PARKWAY DR STE 150
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-4340
Practice Address - Country:US
Practice Address - Phone:847-325-5467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-06742084P0800X
IL036-0791112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry