Provider Demographics
NPI:1548242423
Name:MOLO, MARY WOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:WOOD
Last Name:MOLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 117
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-288-6420
Mailing Address - Fax:312-288-6421
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 117
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-288-6420
Practice Address - Fax:312-288-6421
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067485207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology