Provider Demographics
NPI:1639286156
Name:ILAO-PAHM, MARIA G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:G
Last Name:ILAO-PAHM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2315 E MORELAND BLVD
Mailing Address - Street 2:WESTBROOK WALK-IN CLINIC
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2939
Mailing Address - Country:US
Mailing Address - Phone:262-532-5800
Mailing Address - Fax:262-532-5760
Practice Address - Street 1:2315 E MORELAND BLVD
Practice Address - Street 2:WESTBROOK WALK-IN CLINIC
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2939
Practice Address - Country:US
Practice Address - Phone:262-532-5800
Practice Address - Fax:262-532-5760
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
WI34758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1639286156Medicaid
BI3818967OtherDEA NUMBER
BI3818967OtherDEA NUMBER
F85432Medicare UPIN
WI68086 0657Medicare PIN