Provider Demographics
NPI:1710996988
Name:HRYCELAK, MARIA ROMA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ROMA
Last Name:HRYCELAK
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:101 S WASHINGTON AVE
Mailing Address - Street 2:122
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4200
Mailing Address - Country:US
Mailing Address - Phone:847-692-6628
Mailing Address - Fax:847-692-6891
Practice Address - Street 1:101 S WASHINGTON AVE
Practice Address - Street 2:122
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4200
Practice Address - Country:US
Practice Address - Phone:847-692-6628
Practice Address - Fax:847-692-6891
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036062812208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062812Medicaid