Provider Demographics
NPI:1710205067
Name:AGUIRRE, MARIA TERESA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:TERESA
Other - Last Name:ARCE-LARRETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5120 S KENWOOD AVE
Mailing Address - Street 2:#4
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4391
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9201 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2807
Practice Address - Country:US
Practice Address - Phone:219-836-9024
Practice Address - Fax:219-836-0034
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01074965A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program